MEDICARE: JAMES R RUPPEL 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	207W00000X	Ophthalmology Physician	036064075	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180041717	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1164427613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R RUPPEL M.D.

Provider Business Mailing Address
First Line	:	1008 N MAIN ST
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61701-1784
Country	:	US
Telephone Number	:	309-829-5311
Fax Number	:	309-827-8027

Provider Business Practice Location Address
First Line	:	834 N SEMINARY ST
Second Line	:	STE 103
City	:	GALESBURG
State	:	IL
Zip	:	61401-2852
Country	:	US
Telephone Number	:	309-829-5311
Fax Number	:	309-827-8027

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/06/2016

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