Healthcare Provider Details

I. General information

NPI: 1902969231
Provider Name (Legal Business Name): LEIGH A. RUELO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH A CORRION PA-C

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 N BELL SCHOOL RD
ROCKFORD IL
61114-6624
US

IV. Provider business mailing address

1786 MOON LAKE BLVD., SUITE #100
HOFFMAN ESTATES IL
60169-1016
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-0300
  • Fax: 815-639-9433
Mailing address:
  • Phone: 847-882-9300
  • Fax: 847-882-9348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085002837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: