Provider Demographics
NPI:1467794743
Name:SANMIGUEL, RUBEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:A
Last Name:SANMIGUEL
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 1:602 S PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2258
Mailing Address - Country:US
Mailing Address - Phone:847-394-5208
Mailing Address - Fax:
Practice Address - Street 1:602 S PATTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2258
Practice Address - Country:US
Practice Address - Phone:847-394-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.043689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist