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General NPI Number Information
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NPI Number | 1578521902
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Entity Type | Individual
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Provider Name | PHILIP STANLEY PALUTSIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 4413 ROOSEVELT RD SUITE 101
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City | HILLSIDE
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State | IL
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Zip | 60162-2074
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Country | US
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Telephone | 708-449-0741
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Fax | 708-449-0994
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Provider Business Mailing Address
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Address Line | 1730 PARK ST SUITE 101
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City | NAPERVILLE
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State | IL
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Zip | 60563-2688
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Country | US
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Telephone | 630-718-0200
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Fax | 630-718-0900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 036062738
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License Number State | IL
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