Healthcare Provider Details

I. General information

NPI: 1467619460
Provider Name (Legal Business Name): RUCHIKA GUTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5758 S MARYLAND AVE MC 9006
CHICAGO IL
60637-1426
US

IV. Provider business mailing address

445 E OHIO ST 3614
CHICAGO IL
60611-3302
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number125052441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: