Individual
DR. SANTI RUKVIDTAYASAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7047 NORTH AVE, OAK PARK, IL 60302-1015
(708) 383-0300
Mailing address
7047 NORTH AVE, OAK PARK, IL 60302-1015
(708) 383-0300
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036-050639
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01615155
BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/28/2007
Last updated
07/08/2007
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