Healthcare Provider Details

I. General information

NPI: 1619087707
Provider Name (Legal Business Name): SHELENE S. RUGGIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N DETROIT ST
LAGRANGE IN
46761-1158
US

IV. Provider business mailing address

PO BOX 236
LAGRANGE IN
46761-0236
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-2133
  • Fax: 260-463-3775
Mailing address:
  • Phone: 260-463-2133
  • Fax: 260-463-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01062633A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01062633A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: