Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 38.11987 | IL |
NPI | 1962789545 |
---|---|
Provider Name | Dr. Eric Benjamin Ruble |
First Address | Chicago, IL 60613-1348 |
Second Address | Chicago, IL 60613-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2011 |
Last Update Date | 09/11/2011 |