MEDICARE: DR. SARA RUDDOCK-WALKER 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	208000000X	Pediatrics Physician	125.069373	IL
2	207R00000X	Internal Medicine Physician	036.151710	IL
3	208000000X	Pediatrics Physician	036.151710	IL
4	208M00000X	Hospitalist Physician	036151710	IL

General Provider Information

NPI Number	:	1558711101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA RUDDOCK-WALKER M.D.

Provider Business Mailing Address
First Line	:	25 N WINFIELD RD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1379
Country	:	US
Telephone Number	:	630-933-4700
Fax Number	:	630-933-4427

Provider Business Practice Location Address
First Line	:	25 N WINFIELD RD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1379
Country	:	US
Telephone Number	:	630-933-4700
Fax Number	:	630-933-4427

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

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	02/18/2026

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