Healthcare Provider Details

I. General information

NPI: 1124101548
Provider Name (Legal Business Name): RUSH OTOLARYNGOLOGY HEAD AND NECK SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST SUITE 550
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

1611 W HARRISON ST SUITE 550
CHICAGO IL
60612-4861
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6100
  • Fax: 312-942-6225
Mailing address:
  • Phone: 312-942-6100
  • Fax: 312-942-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID D CALDARELLI
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 312-942-6100