Healthcare Provider Details

I. General information

NPI: 1437787439
Provider Name (Legal Business Name): MITCH RUH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 W 95TH ST
OAK LAWN IL
60453-2458
US

IV. Provider business mailing address

5S230 SWAN RD
BIG ROCK IL
60511-9772
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-3480
  • Fax:
Mailing address:
  • Phone: 630-546-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: