Organization
MAYUGA MEDICAL PRACTICE
Active
Organization
MAYUGA MEDICAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUPERTO MAYUGA M.D. (PRESIDENT)
(773) 281-7660
Entity
Organization
Contact information
Practice address
2800 N SHERIDAN RD, SUITE303, CHICAGO, IL 60657-6156
(773) 281-7660
Mailing address
18W 163 HOLLY AVE, DARIEN, IL 60561
(847) 676-0091
(847) 676-2374
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
03/25/2014
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