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General NPI Number Information
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NPI Number | 1548572696
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Entity Type | Individual
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Provider Name | STEFANIE RUFFOLO M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 6121 GREEN BAY RD STE 100
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City | KENOSHA
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State | WI
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Zip | 53142-2931
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Country | US
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Telephone | 262-220-7294
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Fax |
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Provider Business Mailing Address
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Address Line | 3805 13TH PL
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City | KENOSHA
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State | WI
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Zip | 53144-2942
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Country | US
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Telephone | 262-220-7294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MT197580
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT197580
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 63334
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 63334
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 63334
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License Number State | WI
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