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General NPI Number Information
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NPI Number | 1285503797
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Entity Type | Organization
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Legal Business Name | RUSH OAK PARK PHYSICIANS GROUP LAKE STREET
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 230 W MONROE ST STE 100
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City | CHICAGO
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State | IL
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Zip | 60606
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Country | US
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Telephone | 888-663-6331
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 1700 W VAN BUREN ST STE 161
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City | CHICAGO
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State | IL
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Zip | 60612-3228
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Country | US
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Telephone | 312-563-4577
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Fax | 312-563-4777
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Authorized Official
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Title or Position | VP MEDICAL GROUP OPERATIONS
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Name | BRADEN MANTEI
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Credential |
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Telephone | 312-942-3404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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