MEDICARE: ESTELA S RUTIAGA 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	036128008	IL
2	261QU0200X	Urgent Care Clinic/Center	036.128008	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083876064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTELA S RUTIAGA M.D.

Provider Business Mailing Address
First Line	:	8201 E RIVERSIDE BLVD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-2300
Country	:	US
Telephone Number	:	815-971-7000
Fax Number	:	815-968-4795

Provider Business Practice Location Address
First Line	:	8201 EAST RIVERSIDE BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1296
Country	:	US
Telephone Number	:	815-971-7000
Fax Number	:	815-968-4795

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	05/12/2026

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