Healthcare Provider Details

I. General information

NPI: 1588700462
Provider Name (Legal Business Name): RON W DORUSHKA RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 MC DUFFEE CIR
NORTH AURORA IL
60542-2030
US

IV. Provider business mailing address

2753 MC DUFFEE CIR
NORTH AURORA IL
60542-2030
US

V. Phone/Fax

Practice location:
  • Phone: 630-907-2337
  • Fax:
Mailing address:
  • Phone: 630-907-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: