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NPI Code Detail

MEDICARE: DR. RUTH DITZIAN-KADANOFF MD PHD

MEDICARE: DR. RUTH DITZIAN-KADANOFF MD PHD
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
1207RR0500XRheumatology Physician36069150IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891772760
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUTH DITZIAN-KADANOFF MD PHD
Provider Business Mailing Address
First Line : 1634 W POLK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-4352
Country : US
Telephone Number : 312-423-4200
Fax Number : 312-829-3742
Provider Business Practice Location Address
First Line : 5000 S 5TH AVE
Second Line :
City : HINES
State : IL
Zip : 60141-3030
Country : US
Telephone Number : 708-202-2707
Fax Number : 708-202-3633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 03/23/2018

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