Healthcare Provider Details

I. General information

NPI: 1699720557
Provider Name (Legal Business Name): GALILEE MEDICAL CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 W FULLERTON AVE
CHICAGO IL
60639-2503
US

IV. Provider business mailing address

5023 N LINCOLN AVE
CHICAGO IL
60625-2611
US

V. Phone/Fax

Practice location:
  • Phone: 773-622-1200
  • Fax: 773-637-5985
Mailing address:
  • Phone: 773-293-0451
  • Fax: 773-293-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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