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General NPI Number Information
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NPI Number | 1609823038
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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 | 05/30/2006
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Last Update Date | 03/05/2019
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Provider Practice Location 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 | 773-293-0451
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Fax | 773-942-7166
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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 | 773-293-0451
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Fax | 773-942-7166
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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 | 773-237-0755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 42618056
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License Number State | IL
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