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General NPI Number Information
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NPI Number | 1194096610
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Entity Type | Organization
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Legal Business Name | RUSH OAK PARK PHYSICIANS GROUP FAMILY MEDICINE
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 610 S MAPLE AVE SUITE 2500
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City | OAK PARK
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State | IL
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Zip | 60304-1091
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Country | US
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Telephone | 708-660-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 610 S MAPLE AVE SUITE 2500
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City | OAK PARK
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State | IL
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Zip | 60304-1091
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Country | US
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Telephone | 708-660-2900
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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 | SCOTT A HALPER
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Credential |
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Telephone | 312-942-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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