Basic Information
| Provider Information | |||||||||
| NPI: | 1053347989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9000 W WISCONSIN AVE | ||||||||
| Address2: | PEDIATRIC PULMONARY MEDICINE | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142666730 | ||||||||
| FaxNumber: | 4142666742 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 W WISCONSIN AVE | ||||||||
| Address2: | PEDIATRIC PULMONARY MEDICINE | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142666730 | ||||||||
| FaxNumber: | 4142666742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 09/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301086770 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | 46902 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0214X | 46902 | WI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | 1053347989 | 05 | WI | MEDICAID | 1598712390 | 01 | MI | GROUP NPI | OTHER | 381360529 | 01 | MI | TAX ID# | OTHER | 4876074 | 05 | MI | MEDICAID | 4876092 | 05 | MI | MEDICAID | 4876109 | 05 | MI | MEDICAID | 4876083 | 05 | MI | MEDICAID | 080416161 | 01 | MI | BCBS | OTHER | 4876065 | 05 | MI | MEDICAID |