Provider Demographics
NPI:1144300534
Name:PUTRUS, RAMIZ (MD)
Entity type:Individual
Prefix:
First Name:RAMIZ
Middle Name:
Last Name:PUTRUS
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 1:116 W 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-2433
Mailing Address - Country:US
Mailing Address - Phone:248-541-7606
Mailing Address - Fax:248-541-7197
Practice Address - Street 1:165 S 1ST ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4795
Practice Address - Country:US
Practice Address - Phone:619-312-0347
Practice Address - Fax:619-749-5480
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49570207Q00000X
MI4301061917207Q00000X
CAA68184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1059106470OtherAMERICAN BOARD OF FAMILY MEDICINE
CAFP5365487OtherDEA
1059106470OtherAMERICAN BOARD OF FAMILY MEDICINE