Provider Demographics
NPI:1619087707
Name:RUGGIO, SHELENE S (MD)
Entity Type:Individual
Prefix:
First Name:SHELENE
Middle Name:S
Last Name:RUGGIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9127
Mailing Address - Country:US
Mailing Address - Phone:260-437-5332
Mailing Address - Fax:260-572-2341
Practice Address - Street 1:503 STEEPLECHASE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-9127
Practice Address - Country:US
Practice Address - Phone:260-437-5332
Practice Address - Fax:260-572-2341
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062633A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200832040Medicaid
IN000000488751OtherANTHEM
P00390092OtherRAILROAD
OH2718303Medicaid
IN000000488751OtherANTHEM
IN200832040Medicaid
OH2718303Medicaid