MEDICARE: DR. ALFREDO ESTEVAN RUMILLA II M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-095178	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0021623247	OTHER	IL	ILLINOIS BLUE CROSS/BLUE

General Provider Information

NPI Number	:	1063594554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFREDO ESTEVAN RUMILLA II M.D.

Provider Business Mailing Address
First Line	:	2554 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3148
Country	:	US
Telephone Number	:	773-687-9490
Fax Number	:	773-687-9637

Provider Business Practice Location Address
First Line	:	2554 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3148
Country	:	US
Telephone Number	:	773-342-8888
Fax Number	:	773-342-6257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	11/10/2020

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