Provider Demographics
NPI:1760469738
Name:RUCKAUF, JOHN CHARLES (APN/NP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:RUCKAUF
Suffix:
Gender:M
Credentials:APN/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1205
Mailing Address - Country:US
Mailing Address - Phone:773-880-3278
Mailing Address - Fax:773-880-4063
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:MAIL STOP #54
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-3278
Practice Address - Fax:773-880-4063
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000491 (41-13328363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics