Provider Demographics
NPI:1023036514
Name:VICTOR M. CRUZ MD, P.C.
Entity Type:Organization
Organization Name:VICTOR M. CRUZ MD, P.C.
Other - Org Name:CRUZ CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-462-3210
Mailing Address - Street 1:17177 N LAUREL PARK DR
Mailing Address - Street 2:SUITE 131
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2693
Mailing Address - Country:US
Mailing Address - Phone:734-462-3210
Mailing Address - Fax:734-462-1024
Practice Address - Street 1:17177 N LAUREL PARK DR
Practice Address - Street 2:SUITE 131
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2693
Practice Address - Country:US
Practice Address - Phone:734-462-3210
Practice Address - Fax:734-462-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1112Medicare PIN