Provider Demographics
NPI:1427215680
Name:RUDA, TOHFA MANJI (DO)
Entity type:Individual
Prefix:DR
First Name:TOHFA
Middle Name:MANJI
Last Name:RUDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TOHFA
Other - Middle Name:AMIN
Other - Last Name:MANJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1273 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9318
Practice Address - Country:US
Practice Address - Phone:773-377-9910
Practice Address - Fax:773-377-9941
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1259892083P0901X, 202D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209753004OtherMEDICARE INDIVIDUAL PTAN
IL036125989Medicaid
IL20020440OtherILLINOIS HEALTH CONNECT
IL1628468OtherBCBS PROVIDER NUMBER