Healthcare Provider Details

I. General information

NPI: 1699611012
Provider Name (Legal Business Name): MR. NAPOLEON RUCKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W CERMAK RD STE 630
CHICAGO IL
60608-4560
US

IV. Provider business mailing address

7948 S CHAMPLAIN AVE APT 3
CHICAGO IL
60619-3080
US

V. Phone/Fax

Practice location:
  • Phone: 833-745-3268
  • Fax:
Mailing address:
  • Phone: 708-979-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: