# SOUTHWEST RHEUMATOLOGY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205958923
- **Authorized official:** PAUL DELBUSTO M.D (DOCTOR)
- **Authorized official phone:** (708) 423-1130

## Contact information

- **Practice address:** 2850 W 95TH ST, SUITE 200, EVERGREEN PARK, IL 60805-2735
- **Practice address phone:** (708) 423-1130
- **Practice address fax:** (708) 423-3610
- **Mailing address:** 2850 W 95TH ST, SUITE 200, EVERGREEN PARK, IL 60805-2735
- **Mailing address phone:** (708) 423-1130
- **Mailing address fax:** (708) 423-3610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RR0500X | Rheumatology Physician | 036083298 | IL | Yes |

## Other

- **Enumeration date:** 04/04/2007
- **Last updated:** 08/30/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01632140 | BCBS OF IL | IL |
| 01 | — | CJ6175 | RR MEDICARE | IL |