Provider Demographics
NPI:1245360726
Name:RUIZ MONTERO, JAIME E (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:E
Last Name:RUIZ MONTERO
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 1:9660 WICKER AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9487
Mailing Address - Country:US
Mailing Address - Phone:219-397-8965
Mailing Address - Fax:219-397-9351
Practice Address - Street 1:4320 FIR STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3052
Practice Address - Country:US
Practice Address - Phone:219-397-8965
Practice Address - Fax:219-397-9351
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052348207R00000X
IN01052348A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90001247OtherBCBSIL
IN000000224980OtherANTHEM
000000224980OtherANTHEM BCBS
IN200287720BMedicaid
000000224980OtherANTHEM BCBS
IL90001247OtherBCBSIL