Provider Demographics
NPI:1083602379
Name:DR RON RIEGELHAUPT
Entity Type:Organization
Organization Name:DR RON RIEGELHAUPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:RIEGELHAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-729-4710
Mailing Address - Street 1:1775 GLENVIEW RD
Mailing Address - Street 2:STE 115
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2956
Mailing Address - Country:US
Mailing Address - Phone:847-729-4710
Mailing Address - Fax:847-729-4746
Practice Address - Street 1:1775 GLENVIEW RD
Practice Address - Street 2:STE 115
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2956
Practice Address - Country:US
Practice Address - Phone:847-729-4710
Practice Address - Fax:847-729-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-3156Medicaid
IL480000990OtherMEDICARE RAILROAD
ILDD3445OtherRAILROAD GROUP #
K13040Medicare UPIN
210542Medicare ID - Type Unspecified
IL480000990OtherMEDICARE RAILROAD
K13038Medicare UPIN