Provider Demographics
NPI:1992765283
Name:RUIZ, JOANN EVIOTA (MD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:EVIOTA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4921
Mailing Address - Country:US
Mailing Address - Phone:773-728-4784
Mailing Address - Fax:773-728-4759
Practice Address - Street 1:5641 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4921
Practice Address - Country:US
Practice Address - Phone:773-728-4784
Practice Address - Fax:773-728-4759
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085554Medicaid
ILF69579Medicare UPIN