Provider Demographics
NPI:1891744439
Name:RUETTEN, CATHERINE A (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:RUETTEN
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 1:954 WEST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60118
Mailing Address - Country:US
Mailing Address - Phone:815-895-9144
Mailing Address - Fax:815-899-4234
Practice Address - Street 1:954 WEST STATE STREET
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:815-895-9144
Practice Address - Fax:815-899-4234
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087156Medicaid
ILL31635Medicare ID - Type Unspecified
F73169Medicare UPIN