Provider Demographics
NPI:1225135460
Name:RUGGIE, NEAL (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:RUGGIE
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 1:1725 W HARRISON
Mailing Address - Street 2:SUITE 1138
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-563-3233
Mailing Address - Fax:312-563-3235
Practice Address - Street 1:1725 W HARRISON
Practice Address - Street 2:SUITE 1138
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-563-3233
Practice Address - Fax:312-563-3235
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3650425207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050405Medicaid
IL036050405Medicaid
IL497561Medicare PIN