Provider Demographics
NPI:1861487464
Name:RUGGERO, KATHLEEN A (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:RUGGERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:7804 W COLLEGE DR
Practice Address - Street 2:SUITE 1NW
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1025
Practice Address - Country:US
Practice Address - Phone:708-361-5778
Practice Address - Fax:708-361-5631
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102814207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL602232600OtherUS DEPT OF LABOR
IL036102814Medicaid
IL21622441OtherBCBS PROVIDER ID
ILP00082676OtherRAILROAD MEDICARE
IL21622441OtherBCBS PROVIDER ID