Provider Demographics
NPI:1811322381
Name:RUGGLES, MICHAEL J (MA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:RUGGLES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-1111
Mailing Address - Country:US
Mailing Address - Phone:312-307-6282
Mailing Address - Fax:888-972-1638
Practice Address - Street 1:3100 N 77TH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-1111
Practice Address - Country:US
Practice Address - Phone:312-307-6282
Practice Address - Fax:888-972-1638
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist