MEDICARE: DR. REUBEN C. RUTLAND 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	208600000X	Surgery Physician	01068577A	IN
2	208D00000X	General Practice Physician	36116452	IL

General Provider Information

NPI Number	:	1497802151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REUBEN C. RUTLAND M.D.

Provider Business Mailing Address
First Line	:	2070 W 51ST PL
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46408-4240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7939 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3975
Country	:	US
Telephone Number	:	773-224-4949
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	09/30/2025

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