| Doctor Name: | JOHN L RUSKUSKY |
| NPI Number: | 1114978574 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | 016002661 |
| Business Practice Address: | 3305 Griffin Ave Pekin, IL - 615546237 |
| Business Phone Number: | 3093473886 |
| Business Fax Number: | 3093474002 |
| Mailing Address: | 3305 Griffin Ave, PEKIN |
| State: | IL |
| Postal Code: | 615546237 |
| Phone Number: | 3093473886 |
| Fax Number: | 3093474002 |
| NPI Enumeration Date: | 05/12/2006 |
| NPI Last Update Date: | 11/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 016002661 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |