Healthcare Provider Details

I. General information

NPI: 1003186255
Provider Name (Legal Business Name): RUSH OAK PARK PHYSICIANS GROUP NORTH RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 W CERMAK RD SUITE 700
NORTH RIVERSIDE IL
60546-1422
US

IV. Provider business mailing address

7222 W CERMAK RD SUITE 700
NORTH RIVERSIDE IL
60546-1422
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-6400
  • Fax:
Mailing address:
  • Phone: 708-660-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT A HALPER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 312-942-7770