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General NPI Number Information
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NPI Number | 1760469738
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Entity Type | Individual
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Provider Name | JOHN CHARLES RUCKAUF APN/NP
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Gender | Male
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 2300 N CHILDRENS PLZ MAIL STOP #54
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City | CHICAGO
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State | IL
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Zip | 60614-3363
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Country | US
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Telephone | 773-880-3278
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Fax | 773-880-4063
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Provider Business Mailing Address
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Address Line | 727 S EUCLID AVE
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City | OAK PARK
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State | IL
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Zip | 60304-1205
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Country | US
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Telephone | 773-880-3278
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Fax | 773-880-4063
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209-000491 (41-13328
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License Number State | IL
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