Healthcare Provider Details

I. General information

NPI: 1104179126
Provider Name (Legal Business Name): RICHARD J PATUSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 N CUMBERLAND AVE
NORRIDGE IL
60706-2919
US

IV. Provider business mailing address

597 N YORK ST
ELMHURST IL
60126-1903
US

V. Phone/Fax

Practice location:
  • Phone: 708-456-2930
  • Fax:
Mailing address:
  • Phone: 630-833-8382
  • Fax: 630-833-8158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: