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General NPI Number Information
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NPI Number | 1609120138
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Entity Type | Organization
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Legal Business Name | PHYSICIAN URGENT CARE OF ILLINOIS, INC.
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 1554 TODD FARM DR
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City | ELGIN
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State | IL
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Zip | 60123-1287
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Country | US
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Telephone | 847-888-7423
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Fax | 847-841-7285
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Provider Business Mailing Address
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Address Line | 4941 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5009
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Country | US
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Telephone | 773-309-6714
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Fax | 773-309-6298
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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