Healthcare Provider Details

I. General information

NPI: 1851420319
Provider Name (Legal Business Name): RUSH UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST SUITE 130
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

600 S PAULINA ST SUITE 130
CHICAGO IL
60612-3806
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3333
  • Fax: 312-942-4154
Mailing address:
  • Phone: 312-942-3333
  • Fax: 312-942-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJ C SHAH
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 312-563-2902