Doctor Name: | DR. REUBEN C. RUTLAND |
NPI Number: | 1497802151 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 36116452 |
Business Practice Address: | 7939 S Cottage Grove Ave Chicago, IL - 606193975 |
Business Phone Number: | 7732244949 |
Business Fax Number: | |
Mailing Address: | 2070 W 51st Pl, GARY |
State: | IN |
Postal Code: | 464084240 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/04/2007 |
NPI Last Update Date: | 09/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 36116452 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |