| Theodore J Ruza Do Pc | |
|
7001 Orchard Lake Rd Suite 424 West Bloomfield MI 48322-3604 | |
| (248) 626-4600 | |
| (248) 626-3988 |
| Full Name | Theodore J Ruza Do Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7001 Orchard Lake Rd, West Bloomfield, Michigan |
| Authorized Official Name and Position | Theodore J Ruza (OWNER) |
| Authorized Official Contact | 2486264600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore J Ruza Do Pc 7001 Orchard Lake Rd Suite 424 West Bloomfield MI 48322-3604 Ph: (248) 626-4600 | Theodore J Ruza Do Pc 7001 Orchard Lake Rd Suite 424 West Bloomfield MI 48322-3604 Ph: (248) 626-4600 |
| NPI Number | 1033323449 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9436259843 |
|---|---|
| Medicare Enrollment ID | O20070714000107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033323449 | NPI | - | NPPES |
| 5631523 | Other | MI | BCBS ID NUMBER |
| 2805977 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | TR009905 (Michigan) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | TR009905 (Michigan) | Primary |
| Provider Name | Theodore J Ruza |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346392735 PECOS PAC ID: 4981704392 Enrollment ID: I20070714000101 |
| Provider Name | Darcy L Paisley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134851074 PECOS PAC ID: 3779614813 Enrollment ID: I20221107001912 |
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