Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036-05772 | IL |
N | 2080P0201X | Pediatric Allergist | 036=05772 | IL |
N | 2080P0202X | Pediatric Cardiologist | 036-05772 | IL |
NPI | 1972690212 |
---|---|
Provider Name | Dr. William David Rutenberg |
First Address | Buffalo Grove, IL 60089-8213 |
Second Address | Buffalo Grove, IL 60089-8213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 15/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C45326 | (02) |