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General NPI Number Information
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NPI Number | 1497797393
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Entity Type | Organization
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Legal Business Name | GALILEE MEDICAL CENTER, S.C.
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 4849 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60639-2503
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Country | US
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Telephone | 773-309-6740
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Fax | 773-237-6606
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Provider Business Mailing Address
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Address Line | 4903 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60639-2548
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Country | US
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Telephone | 773-237-0755
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Fax | 773-237-0785
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NASER RUSTOM
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Credential | MD
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Telephone | 773-237-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 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 #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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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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