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General NPI Number Information
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NPI Number | 1760821839
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Entity Type | Organization
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Legal Business Name | RUSTUM HEALTH NETWORK
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 2827 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60623-3513
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Country | US
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Telephone | 773-823-1802
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Fax | 773-823-1814
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Provider Business Mailing Address
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Address Line | PO BOX 220278
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City | CHICAGO
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State | IL
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Zip | 60622-0278
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Country | US
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Telephone | 773-823-1802
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Fax | 773-823-1814
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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 | MD
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Telephone | 773-283-1802
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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 | 036044669
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License Number State | IL
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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 | 036083101
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License Number State | IL
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