Provider Demographics
NPI:1760986921
Name:RUTLEDGE, TAYLOR (DO)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 W RASCHER AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1205
Mailing Address - Country:US
Mailing Address - Phone:312-436-1015
Mailing Address - Fax:
Practice Address - Street 1:3304 N LINCOLN AVE STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1108
Practice Address - Country:US
Practice Address - Phone:312-436-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75616-212083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine