Healthcare Provider Details

I. General information

NPI: 1649365529
Provider Name (Legal Business Name): RUSHDI ALUL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

IV. Provider business mailing address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-3439
  • Fax: 312-770-3373
Mailing address:
  • Phone: 312-770-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-116733
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036116733
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: