Provider Demographics
NPI:1285669325
Name:CRUZ, VICTOR M (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:CRUZ
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 1:17177 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010268372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB46032Medicare UPIN