Provider Demographics
NPI:1033323449
Name:THEODORE J RUZA DO PC
Entity Type:Organization
Organization Name:THEODORE J RUZA DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-626-4600
Mailing Address - Street 1:7001 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 424
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3604
Mailing Address - Country:US
Mailing Address - Phone:248-626-4600
Mailing Address - Fax:248-626-3988
Practice Address - Street 1:7001 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 424
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3604
Practice Address - Country:US
Practice Address - Phone:248-626-4600
Practice Address - Fax:248-626-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITR009905103TP0016X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5631523OtherBCBS ID NUMBER
MI2805977Medicaid
MI2805977Medicaid
MI5631523OtherBCBS ID NUMBER