Healthcare Provider Details

I. General information

NPI: 1861487464
Provider Name (Legal Business Name): KATHLEEN A RUGGERO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7804 W COLLEGE DR SUITE 1NW
PALOS HEIGHTS IL
60463-1025
US

IV. Provider business mailing address

777 OAKMONT LN SUITE 1600
WESTMONT IL
60559-5511
US

V. Phone/Fax

Practice location:
  • Phone: 708-361-5778
  • Fax: 708-361-5631
Mailing address:
  • Phone: 630-789-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036102814
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: