Provider Demographics
NPI:1013286491
Name:RUDER, HENRY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOSEPH
Last Name:RUDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LATHROP AVE UNIT 3E
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1894
Mailing Address - Country:US
Mailing Address - Phone:708-542-9359
Mailing Address - Fax:708-575-0882
Practice Address - Street 1:411 LATHROP AVE UNIT 3E
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1894
Practice Address - Country:US
Practice Address - Phone:708-542-9359
Practice Address - Fax:708-575-0882
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0336-012723OtherILLINOIS NARCOTIC LICENSE
IL036046038OtherILLINOIS MEDICAL LICENSE
IL036046038OtherILLINOIS MEDICAL LICENSE
IL036046038OtherILLINOIS MEDICAL LICENSE