Provider Demographics
NPI:1588834840
Name:EDWARD RUIZ, M.D., P.C.
Entity Type:Organization
Organization Name:EDWARD RUIZ, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-651-1010
Mailing Address - Street 1:PO BOX 80856
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308-0856
Mailing Address - Country:US
Mailing Address - Phone:248-651-1010
Mailing Address - Fax:586-997-4279
Practice Address - Street 1:51850 DEQUINDRE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-2806
Practice Address - Country:US
Practice Address - Phone:248-651-1010
Practice Address - Fax:586-997-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061025207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4327804Medicaid
MI0N30290Medicare PIN
MI4327804Medicaid