Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301086770 | MI |
N | 208000000X | Pediatrician | 46902 | WI |
Y | 2080P0214X | Pediatric Pulmonologist | 46902 | WI |
NPI | 1053347989 |
---|---|
Provider Name | Juan P Ruiz |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 11/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080416161 | BCBS (01) | MI |
1053347989 | (05) | WI |
1598712390 | GROUP NPI (01) | MI |
381360529 | TAX ID# (01) | MI |
4876065 | (05) | MI |
4876074 | (05) | MI |
4876083 | (05) | MI |
4876092 | (05) | MI |
4876109 | (05) | MI |