Individual
STEFANIE RUFFOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6121 GREEN BAY RD STE 100, KENOSHA, WI 53142-2931
(262) 220-7294
Mailing address
3805 13TH PL, KENOSHA, WI 53144-2942
(262) 220-7294
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
63334
WI
207R00000X
Internal Medicine Physician
MT197580
PA
208000000X
Pediatrics Physician
63334
WI
208000000X
Pediatrics Physician
MT197580
PA
2080P0203X
Pediatric Critical Care Medicine Physician
63334
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548572696
—
WI
Enumeration date
07/06/2010
Last updated
02/04/2016
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