Provider Demographics
NPI:1235124561
Name:RUFFOLO, ALDO CARMEN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALDO
Middle Name:CARMEN
Last Name:RUFFOLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W LINCOLN AVE
Mailing Address - Street 2:PO BOX 770
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2413
Mailing Address - Country:US
Mailing Address - Phone:312-576-4285
Mailing Address - Fax:217-345-8366
Practice Address - Street 1:907 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2413
Practice Address - Country:US
Practice Address - Phone:217-345-2100
Practice Address - Fax:217-345-8366
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361001632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100163Medicaid
H07212Medicare UPIN
ILL70706Medicare ID - Type Unspecified