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NPI Code Detail

MEDICARE: DR. TOHFA MANJI RUDA DO

MEDICARE: DR. TOHFA MANJI RUDA DO
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
12083P0901XPublic Health & General Preventive Medicine Physician036.125989IL
2207Q00000XFamily Medicine Physician036.125989IL
3202D00000XIntegrative Medicine Physician036.125989IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1209753004OTHERILMEDICARE INDIVIDUAL PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
320020440OTHERILILLINOIS HEALTH CONNECT
41628468OTHERILBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1427215680
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TOHFA MANJI RUDA DO
Provider Business Mailing Address
First Line : 29373 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1293
Country : US
Telephone Number : 847-390-5900
Fax Number :
Provider Business Practice Location Address
First Line : 4440 W. 95TH STREET, OUTPATIENT PAVILION 8TH FLOOR
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-2600
Country : US
Telephone Number : 708-684-9560
Fax Number : 708-520-3002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2008
Last Update Date : 01/06/2026

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