MEDICARE: MR. NAPOLEON RUCKER

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	247ZC0005X	Clinical Laboratory Director (Non-physician)
2	246Q00000X	Pathology Specialist/Technologist

General Provider Information

NPI Number	:	1699611012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NAPOLEON RUCKER

Provider Business Mailing Address
First Line	:	7948 S CHAMPLAIN AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3080
Country	:	US
Telephone Number	:	708-979-2668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 W CERMAK RD STE 630
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4560
Country	:	US
Telephone Number	:	833-745-3268
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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