Provider Demographics
NPI:1669576757
Name:RUZKOWSKI, CHARLES J (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:RUZKOWSKI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2749
Practice Address - Country:US
Practice Address - Phone:719-595-7680
Practice Address - Fax:719-595-7687
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-23100207RG0100X
CO39991207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90023030Medicaid
COC807916Medicare PIN