Healthcare Provider Details

I. General information

NPI: 1023710274
Provider Name (Legal Business Name): NEAL FRANCIS DAVIS-RUPERTO AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

4816 N WOLCOTT AVE APT 2
CHICAGO IL
60640-8224
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3184
  • Fax:
Mailing address:
  • Phone: 559-974-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001700
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: