Provider Demographics
NPI:1467402065
Name:RUEBKE, ERIC A (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:RUEBKE
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:PO BOX 1467
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1467
Mailing Address - Country:US
Mailing Address - Phone:681-457-5200
Mailing Address - Fax:618-351-4821
Practice Address - Street 1:201 S 14TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3631
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:618-988-6186
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106061207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106061-2Medicaid
IL036106061-3Medicaid
KY7100098030Medicaid
IL036106061-2Medicaid
P00428391Medicare PIN
K28552Medicare PIN
ILIL1943009Medicare PIN
IL214881061Medicare PIN
213567Medicare PIN
DE7181Medicare PIN