Provider Demographics
NPI:1083472864
Name:PRUSS, OLIVIA KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:KATHERINE
Last Name:PRUSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:180 HARVESTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE # MC2050
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:773-834-0598
Practice Address - Fax:773-702-0840
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.086227207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology