Individual
DR. ALICE M RUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4050 HEALTHWAY DR, SUITE 140, AURORA, IL 60504-8183
(630) 318-3355
(630) 701-9277
Mailing address
4050 HEALTHWAY DR, SUITE 140, AURORA, IL 60504-8183
(630) 318-3355
(630) 701-9277
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036083796
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036083796
—
IL
01
—
110240875
MEDICARE RAILROAD
IL
01
—
271168698
TAX ID#
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
Enumeration date
07/24/2006
Last updated
08/10/2012
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