Provider Demographics
NPI:1669636122
Name:RUTA, PETER
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:RUTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8232 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3521
Mailing Address - Country:US
Mailing Address - Phone:414-371-1147
Mailing Address - Fax:414-461-1049
Practice Address - Street 1:5626 N 91ST ST STE 301
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-2745
Practice Address - Country:US
Practice Address - Phone:414-461-1088
Practice Address - Fax:414-461-1049
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43735600Medicaid