Healthcare Provider Details

I. General information

NPI: 1548384092
Provider Name (Legal Business Name): MAUREEN ELLEN RUDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR ST SUITE 207
MELROSE PARK IL
60160-4138
US

IV. Provider business mailing address

1111 SUPERIOR ST SUITE 207
MELROSE PARK IL
60160-4138
US

V. Phone/Fax

Practice location:
  • Phone: 708-406-3040
  • Fax: 708-406-3059
Mailing address:
  • Phone: 708-406-3040
  • Fax: 708-406-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036065525
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: