| The Ruth Institute Of Integrative Care Llc | |
|
5 Revere Dr Ste 200 Northbrook IL 60062-8000 | |
| (917) 475-6181 | |
| Not Available |
| Full Name | The Ruth Institute Of Integrative Care Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5 Revere Dr Ste 200, Northbrook, Illinois |
| Authorized Official Name and Position | Diego Marin (OWNER) |
| Authorized Official Contact | 9174756181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Ruth Institute Of Integrative Care Llc 5 Revere Dr Ste 200 Northbrook IL 60062-8000 Ph: () - | The Ruth Institute Of Integrative Care Llc 5 Revere Dr Ste 200 Northbrook IL 60062-8000 Ph: (917) 475-6181 |
| NPI Number | 1538745153 |
|---|---|
| Provider Enumeration Date | 03/23/2021 |
| Last Update Date | 03/23/2021 |
| Certification Date | 03/01/2021 |
| Medicare PECOS PAC ID | 1153720008 |
|---|---|
| Medicare Enrollment ID | O20210525002542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538745153 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Diego Marin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750818746 PECOS PAC ID: 9032448550 Enrollment ID: I20190909003797 |
| Provider Name | Michael G Bonifacio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275310146 PECOS PAC ID: 8426408998 Enrollment ID: I20231223000331 |
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