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 1:1 FORD PL STE 3A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:313-876-4806
Mailing Address - Fax:
Practice Address - Street 1:7100 BERRYHILL ST
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-5101
Practice Address - Country:US
Practice Address - Phone:248-847-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51010099052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI511709OtherCARE CHOICES
260017749OtherPALMETTO GBA
MI2805977Medicaid
MI2756315234OtherBLUE CROSS BLUE SHIELD
MI2756337455OtherBLUE CROSS BLUE SHIELD
063237OtherVALUE OPTIONS
4261534OtherAETNA
093876000OtherMAGELLAN
MI511709OtherCARE CHOICES
MI2756337455OtherBLUE CROSS BLUE SHIELD