Individual
TIMOTHY RUSTHOVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
Mailing address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
550
WI
213E00000X
Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003921 4
—
IL
05
—
43225700
—
WI
Enumeration date
12/26/2006
Last updated
07/08/2007
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