Provider Demographics
NPI:1356334171
Name:RUIZ ANDIA, MARCO ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANDRES
Last Name:RUIZ ANDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:A
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 743144
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8900 N. KENDALL DR
Practice Address - Street 2:MIAMI CANCER INSTITUTE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:786-596-2000
Practice Address - Fax:305-279-7778
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128244207RH0003X
PR15149207R00000X
LAMD.15618R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017425800Medicaid
LA1074101Medicaid
LA203302929OtherEIN