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General NPI Number Information
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NPI Number | 1790946929
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Entity Type | Organization
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Legal Business Name | RDI VEIN LLC
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 2502 GALEN DRIVE SUITE 101
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City | CHAMPAIGN
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State | IL
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Zip | 61821
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Country | US
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Telephone | 217-355-8346
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Fax | 217-355-8347
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Provider Business Mailing Address
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Address Line | 2502 GALEN DRIVE SUITE 101
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City | CHAMPAIGN
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State | IL
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Zip | 61821-7049
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Country | US
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Telephone | 217-355-8346
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Fax | 217-355-8347
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALDO C RUFFOLO
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Credential | DO
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Telephone | 217-355-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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