Individual
DR. DEMETRA VLAGOS RUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
302 RANDALL RD, GENEVA, IL 60134-4209
(630) 208-6775
(630) 208-7937
Mailing address
302 RANDALL RD, GENEVA, IL 60134-4209
(630) 208-6775
(630) 208-7937
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
036115634
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-115634
IL LICENSE #
IL
05
—
036115634
—
IL
01
—
201557001
MEDICARE PTAN
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147110
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CE8792
RAILROAD MEDICARE PTAN (GROUP)
IL
01
—
P01090235
RAILROAD MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
04/16/2008
Last updated
11/29/2012
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