Provider Demographics
NPI:1730458316
Name:RUGINO, ALEX JOHN (D O, PA)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JOHN
Last Name:RUGINO
Suffix:
Gender:M
Credentials:D O, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST STE P530
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3486
Mailing Address - Country:US
Mailing Address - Phone:815-932-7200
Mailing Address - Fax:815-935-7874
Practice Address - Street 1:375 N WALL ST STE P530
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3486
Practice Address - Country:US
Practice Address - Phone:815-932-7200
Practice Address - Fax:815-935-7874
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055344363A00000X
IL036166214207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant