MEDICARE: DR. EDWARD A RUFUS JR MD

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	207R00000X	Internal Medicine Physician	036073126	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7200599	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1871597450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD A RUFUS JR MD

Provider Business Mailing Address
First Line	:	206 E MILLER RD
Second Line	:
City	:	EDELSTEIN
State	:	IL
Zip	:	61526-9740
Country	:	US
Telephone Number	:	309-274-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 N KNOXVILLE AVE
Second Line	:	SUITE 306
City	:	PEORIA
State	:	IL
Zip	:	61614-5098
Country	:	US
Telephone Number	:	309-691-7890
Fax Number	:	309-691-7898

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	10/14/2009

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