Provider Demographics
NPI:1265486096
Name:RUIZ, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:RUIZ
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 1:1101 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5502
Mailing Address - Country:US
Mailing Address - Phone:912-350-7171
Mailing Address - Fax:912-350-3454
Practice Address - Street 1:1101 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-7171
Practice Address - Fax:912-350-3454
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA513490585DMedicaid
GA511I110475OtherOLD MEDICARE ID-NON MHUP
GA513490585FMedicaid
SC276409Medicaid
GA551966OtherWELLCARE
GAP00829212OtherRR MEDICARE
01353579OtherAMERIGROUP
GA551966OtherWELLCARE MEDICAID & MEDICARE
GAP00829212OtherRAILROAD MEDICARE
GA513490585DMedicaid
SC276409Medicaid