Healthcare Provider Details

I. General information

NPI: 1972690212
Provider Name (Legal Business Name): WILLIAM DAVID RUTENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N ARLINGTON HEIGHTS RD SUITE 152
BUFFALO GROVE IL
60089-8213
US

IV. Provider business mailing address

135 N ARLINGTON HEIGHTS RD SUITE 152
BUFFALO GROVE IL
60089-8213
US

V. Phone/Fax

Practice location:
  • Phone: 847-465-9600
  • Fax: 847-465-9601
Mailing address:
  • Phone: 847-465-9600
  • Fax: 847-465-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-05772
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number03605772
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036-05772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: