Provider Demographics
NPI:1922171750
Name:RUIZ PLA, HELENE MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:HELENE
Middle Name:MARIE
Last Name:RUIZ PLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 BROADWAY
Mailing Address - Street 2:SUITE103
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-2040
Mailing Address - Country:US
Mailing Address - Phone:708-345-5272
Mailing Address - Fax:708-345-5282
Practice Address - Street 1:1835 BROADWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2040
Practice Address - Country:US
Practice Address - Phone:708-345-5272
Practice Address - Fax:708-345-5282
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079717207R00000X
IL036074432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079717Medicaid
IL0031603786OtherBCBS
E91718Medicare UPIN
ILK12715Medicare ID - Type Unspecified