Healthcare Provider Details

I. General information

NPI: 1427121979
Provider Name (Legal Business Name): SUN YOUNG RUGGERI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 W NORTH AVE STE 100
BROOKFIELD WI
53005-4974
US

IV. Provider business mailing address

13800 W NORTH AVE STE 100
BROOKFIELD WI
53005-4974
US

V. Phone/Fax

Practice location:
  • Phone: 262-754-4488
  • Fax: 262-754-4940
Mailing address:
  • Phone: 262-754-4488
  • Fax: 262-754-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number47562-202
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: