Provider Demographics
NPI:1497708994
Name:DEDDISH, RUTH B (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:B
Last Name:DEDDISH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2300 CHILDRENS PLAZA BOX 45
Mailing Address - Street 2:CHILDRENS MEMORIAL HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3394
Mailing Address - Country:US
Mailing Address - Phone:773-880-4142
Mailing Address - Fax:773-880-3061
Practice Address - Street 1:2300 CHILDRENS PLAZA BOX 45
Practice Address - Street 2:CHILDRENS MEMORIAL HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3394
Practice Address - Country:US
Practice Address - Phone:773-880-4142
Practice Address - Fax:773-880-3061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F58537Medicare UPIN
ILL55654Medicare ID - Type Unspecified