MEDICARE: RUEDA PEDIATRICS, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036091856	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255546966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUEDA PEDIATRICS, S.C.

Provider Business Mailing Address
First Line	:	1746 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1746 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3405
Country	:	US
Telephone Number	:	847-331-1534
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS E RUEDA
Credential	:	M.D.
Telephone Number	:	630-424-1122

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/05/2011

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