Provider Demographics
NPI:1821203548
Name:RIEGELHAUPT, RONALD W
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:RIEGELHAUPT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 GLENVIEW RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2956
Mailing Address - Country:US
Mailing Address - Phone:847-729-4710
Mailing Address - Fax:847-729-4746
Practice Address - Street 1:1775 GLENVIEW RD
Practice Address - Street 2:SUITE 115
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2956
Practice Address - Country:US
Practice Address - Phone:847-729-4710
Practice Address - Fax:847-729-4746
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003156213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDD3445OtherRAILROAD GROUP #
IL016-3156Medicaid
IL480000990OtherRR MEDICARE INDIVIDUAL PTAN
IL480000990OtherRR MEDICARE INDIVIDUAL PTAN
IL0371770003Medicare NSC
ILDD3445OtherRAILROAD GROUP #
ILK13038Medicare UPIN
IL210541Medicare ID - Type UnspecifiedCOOK COUNTY GROUP
IL210542Medicare ID - Type UnspecifiedLAKE COUNTY GROUP