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NPI Code Detail

MEDICARE: DR. GUADALUPE BUSTAMANTE M.D.

MEDICARE: DR. GUADALUPE BUSTAMANTE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036088384IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982692158
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GUADALUPE BUSTAMANTE M.D.
Provider Business Mailing Address
First Line : 4007 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4605
Country : US
Telephone Number : 773-767-2266
Fax Number : 773-767-3933
Provider Business Practice Location Address
First Line : 4007 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4605
Country : US
Telephone Number : 773-767-2266
Fax Number : 773-767-4380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 12/16/2010

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