Individual
RUPERTO MAYUGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2800 N SHERIDAN RD, SUITE 303, CHICAGO, IL 60657-6156
(773) 281-7660
(773) 281-0841
Mailing address
18W 163 HOLLY AVE, DARIEN, IL 60561
(773) 281-7660
(773) 281-0841
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036075687
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01605124
BLUE CROSS BLUE SHIELD IL
IL
05
—
036075687
—
IL
Enumeration date
06/15/2006
Last updated
06/17/2014
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