MEDICARE: ERIC SOUCY RUEFF D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	65935-21	WI
2	2084P0804X	Child & Adolescent Psychiatry Physician	65935-21	WI

General Provider Information

NPI Number	:	1891085130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC SOUCY RUEFF D.O.

Provider Business Mailing Address
First Line	:	4321 W COLLEGE AVE STE 200
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-3968
Country	:	US
Telephone Number	:	920-882-7780
Fax Number	:	920-214-1187

Provider Business Practice Location Address
First Line	:	4321 W COLLEGE AVE STE 200
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-3968
Country	:	US
Telephone Number	:	920-882-7780
Fax Number	:	920-214-1187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	07/19/2024

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