Provider Demographics
NPI:1346392735
Name:RUZA, THEODORE J (DO PC)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:J
Last Name:RUZA
Suffix:
Gender:M
Credentials:DO PC
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Mailing Address - Street 1:21440 ARCHWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336
Mailing Address - Country:US
Mailing Address - Phone:248-426-6930
Mailing Address - Fax:248-477-3732
Practice Address - Street 1:21440 ARCHWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-426-6930
Practice Address - Fax:248-477-3732
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI51010099052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
063237OtherVALUE OPTIONS
260017749OtherPALMETTO GBA
MI2756337455OtherBLUE CROSS BLUE SHIELD
MI2805977Medicaid
093876000OtherMAGELLAN
4261534OtherAETNA
MI2756315234OtherBLUE CROSS BLUE SHIELD
MI511709OtherCARE CHOICES
MI511709OtherCARE CHOICES
MI2756337455OtherBLUE CROSS BLUE SHIELD