Individual
JAIME E RUIZ MONTERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4320 FIR STREET, SUITE 410, EAST CHICAGO, IN 46312-3052
(219) 397-8965
(219) 397-9351
Mailing address
9660 WICKER AVENUE, ST JOHN, IN 46373-9487
(219) 397-8965
(219) 397-9351
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01052348
IN
207R00000X
Internal Medicine Physician
Primary
01052348A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224980
ANTHEM
IN
01
—
000000224980
ANTHEM BCBS
—
05
—
200287720B
—
IN
01
—
90001247
BCBSIL
IL
Enumeration date
03/06/2007
Last updated
01/04/2012
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