Healthcare Provider Details

I. General information

NPI: 1104521871
Provider Name (Legal Business Name): JORDAN RUSHING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 WILLOW SPRINGS RD STE 160
LA GRANGE HIGHLANDS IL
60525-6558
US

IV. Provider business mailing address

5201 WILLOW SPRINGS RD STE 160
LA GRANGE HIGHLANDS IL
60525-6558
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-0920
  • Fax:
Mailing address:
  • Phone: 708-354-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.182144
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: