Provider Demographics
NPI:1184671034
Name:RUIZ-TELLEZ, AXEL (MD)
Entity Type:Individual
Prefix:DR
First Name:AXEL
Middle Name:
Last Name:RUIZ-TELLEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 5TH ST W STE C
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1574
Mailing Address - Country:US
Mailing Address - Phone:239-303-9296
Mailing Address - Fax:239-303-9296
Practice Address - Street 1:2724 5TH ST W STE C
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1574
Practice Address - Country:US
Practice Address - Phone:239-303-9296
Practice Address - Fax:239-303-9296
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE04121Medicare UPIN
FL01668Medicare ID - Type Unspecified