Provider Demographics
NPI:1639185564
Name:RUSKIEWICZ, ROBERT J (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:RUSKIEWICZ
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 1:1040 S 70TH STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-476-9675
Mailing Address - Fax:414-615-0627
Practice Address - Street 1:1040 S 70TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-476-9675
Practice Address - Fax:414-615-0627
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI277830202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000152520OtherMEDICARE SEQ NUMBER RACIN
WI31503600Medicaid
WI31503600Medicaid
WI31503600Medicaid
WI000201823Medicare ID - Type UnspecifiedMILW OP SEQ NUMBER