Healthcare Provider Details

I. General information

NPI: 1922328699
Provider Name (Legal Business Name): CLAUDIA DEL BUSTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 OLD ORCHARD CTR STE 200
SKOKIE IL
60077-1462
US

IV. Provider business mailing address

2801 LAKESIDE DR STE 209
BANNOCKBURN IL
60015-1271
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-3130
  • Fax:
Mailing address:
  • Phone: 847-562-1410
  • Fax: 847-562-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT197617
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number03613446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: