MEDICARE: DR. CHERYL STEPHANIE RUCKER-WHITAKER MD, MPH

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	207RC0000X	Cardiovascular Disease Physician		IL

General Provider Information

NPI Number	:	1821028622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL STEPHANIE RUCKER-WHITAKER MD, MPH

Provider Business Mailing Address
First Line	:	1700 W VAN BUREN ST
Second Line	:	SUITE 470
City	:	CHICAGO
State	:	IL
Zip	:	60612-3218
Country	:	US
Telephone Number	:	312-942-8116
Fax Number	:	312-942-8119

Provider Business Practice Location Address
First Line	:	1700 W VAN BUREN ST
Second Line	:	SUITE 470
City	:	CHICAGO
State	:	IL
Zip	:	60612-3218
Country	:	US
Telephone Number	:	312-942-8116
Fax Number	:	312-942-8119

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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