Healthcare Provider Details

I. General information

NPI: 1518260165
Provider Name (Legal Business Name): RUSH OAK PARK NOCTURNIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MAPLE AVE
OAK PARK IL
60304-1022
US

IV. Provider business mailing address

520 S MAPLE AVE
OAK PARK IL
60304-1022
US

V. Phone/Fax

Practice location:
  • Phone: 708-393-9300
  • Fax:
Mailing address:
  • Phone: 708-393-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

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