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NPI Code Detail

MEDICARE: GALILEE MEDICAL CENTER, S.C.

MEDICARE: GALILEE MEDICAL CENTER, S.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianIL

General Provider Information

NPI Number : 1699720557
Entity Type Code : Organization
Provider Name (Legal Business Name) : GALILEE MEDICAL CENTER, S.C.
Provider Business Mailing Address
First Line : 5023 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2611
Country : US
Telephone Number : 773-293-0451
Fax Number : 773-293-0453
Provider Business Practice Location Address
First Line : 4849 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-2503
Country : US
Telephone Number : 773-622-1200
Fax Number : 773-637-5985
Authorized Official
Title or Position : PRESIDENT
Name : DR. NASER RUSTOM
Credential : MD
Telephone Number : 773-237-0755
Provider Enumeration Date : 05/22/2006
Last Update Date : 08/22/2020

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Directions to “GALILEE MEDICAL CENTER, S.C. ” Practice Location

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