Healthcare Provider Details

I. General information

NPI: 1659537371
Provider Name (Legal Business Name): COLLEEN HELEN RUSCIOLELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN HELEN DROSTE

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC0900
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

150 HARVESTER DR STE 300
BURR RIDGE IL
60527-5965
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-3095
  • Fax: 773-702-0208
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125055052
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.127652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: