Provider Demographics
NPI:1114901881
Name:RUIZ, MICHAEL A (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 CAUGHEY RD
Mailing Address - Street 2:STE 130
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4097
Mailing Address - Country:US
Mailing Address - Phone:814-833-3668
Mailing Address - Fax:888-329-6120
Practice Address - Street 1:1444 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2324
Practice Address - Country:US
Practice Address - Phone:814-866-5141
Practice Address - Fax:814-864-1258
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-004630-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019415170002Medicaid
PA480035188OtherMEDICARE RRB
PA1437498OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA3115582OtherAETNA HMO
PA3115582OtherAETNA HMO
PA0019415170002Medicaid