Provider Demographics
NPI:1336388123
Name:RICHARD A RUZUMNA, M.D.
Entity Type:Organization
Organization Name:RICHARD A RUZUMNA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RUZUMNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-352-1440
Mailing Address - Street 1:29260 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1161
Mailing Address - Country:US
Mailing Address - Phone:248-352-1440
Mailing Address - Fax:248-626-4849
Practice Address - Street 1:29260 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1161
Practice Address - Country:US
Practice Address - Phone:248-352-1440
Practice Address - Fax:248-626-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP13410001Medicare PIN