Provider Demographics
NPI:1033310768
Name:RUFFINO, MICHELLE M (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:RUFFINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:WHITEHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:845 N MICHIGAN AVE, SUITE 923 E
Mailing Address - Street 2:CHICAGO CENTER FOR FACIAL PLASTIC SURGERY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2252
Mailing Address - Country:US
Mailing Address - Phone:312-335-2070
Mailing Address - Fax:312-335-2074
Practice Address - Street 1:845 N MICHIGAN AVE, 923E
Practice Address - Street 2:CHICAGO CENTER FOR FACIAL PLASTIC SURGERY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-335-2070
Practice Address - Fax:312-335-2074
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002047363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ53706Medicare UPIN