Healthcare Provider Details

I. General information

NPI: 1609823038
Provider Name (Legal Business Name): GALILEE MEDICAL CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 N KEDZIE AVE
CHICAGO IL
60625-5009
US

IV. Provider business mailing address

4941 N KEDZIE AVE
CHICAGO IL
60625-5009
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-0451
  • Fax: 773-942-7166
Mailing address:
  • Phone: 773-293-0451
  • Fax: 773-942-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number42618056
License Number StateIL

VIII. Authorized Official

Name: DR. NASER RUSTOM
Title or Position: PRESIDENT
Credential: MD
Phone: 773-237-0755