Provider Demographics
NPI:1871949081
Name:RUZGA, ANTHONY EDWARD (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:EDWARD
Last Name:RUZGA
Suffix:
Gender:M
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:S860 DOLATA CT
Mailing Address - Street 2:
Mailing Address - City:LA VALLE
Mailing Address - State:WI
Mailing Address - Zip Code:53941-9274
Mailing Address - Country:US
Mailing Address - Phone:262-744-1824
Mailing Address - Fax:
Practice Address - Street 1:2000 N DEWEY AVE
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1049
Practice Address - Country:US
Practice Address - Phone:608-524-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0287390200000X
WI75812-20208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program