Warren Rucker, MD
Student in an Organized Health Care Education/Training Program in Chicago, IL. Individual provider (NPI-1).
NPI number1508032632
StatusActive
Last updated in NPPESMay 8, 2008
Details
- NPI
- 1508032632
- Entity type
- Individual (NPI-1)
- Name
- Warren Rucker
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 8, 2008
- Last updated
- May 8, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | 0361121052 | IL | Yes |
Practice location
12230 S Yale AveChicago, IL 60628-6529
Phone 773-995-0292
Mailing address
12230 S Yale AveChicago, IL 60628-6529
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