Healthcare Provider Details

I. General information

NPI: 1104079276
Provider Name (Legal Business Name): RUDY JOHN ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2008
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

225 E CHICAGO AVE # 30
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4562
  • Fax:
Mailing address:
  • Phone: 312-227-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number036-085074
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: