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General NPI Number Information
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NPI Number | 1548323330
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Entity Type | Organization
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Legal Business Name | SAN PABLO MEDICAL CENTER, LTD.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 2641 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-2851
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Country | US
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Telephone | 773-227-3500
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Fax | 773-227-0432
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Provider Business Mailing Address
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Address Line | 2641 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-2851
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Country | US
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Telephone | 773-227-3500
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Fax | 773-227-0432
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Authorized Official
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Title or Position | OWNER
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Name | AMER RUSTUM
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Credential | M.D.
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Telephone | 773-227-3500
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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 | 036083101
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License Number State | IL
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