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General NPI Number Information
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NPI Number | 1174793327
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Entity Type | Organization
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Legal Business Name | RUSH UNIVERSITY PEDIATRIC CARDIAC SURGEONS
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-563-3834
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Fax |
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Provider Business Mailing Address
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Address Line | 1653 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-563-3834
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BRIAN T SMITH
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Credential |
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Telephone | 312-942-6909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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