Basic Information
| Provider Information | |||||||||
| NPI: | 1033310768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUFFINO | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WHITEHALL | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | M. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 845 N MICHIGAN AVE, SUITE 923 E | ||||||||
| Address2: | CHICAGO CENTER FOR FACIAL PLASTIC SURGERY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123352070 | ||||||||
| FaxNumber: | 3123352074 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 N MICHIGAN AVE, 923E | ||||||||
| Address2: | CHICAGO CENTER FOR FACIAL PLASTIC SURGERY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123352070 | ||||||||
| FaxNumber: | 3123352074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 085-002047 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.