# DR. JOHN PAUL FEDERBUSCH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1235261264
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | 036056863 | IL | Yes |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 07/29/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 02215674 | BCBC-IL GRP PROV \# FOR GROUP NAMED: METROPOLITAN MEDICAL CONSULTANTS, S.C. | IL |
| 05 | — | 036056863 | — | IL |
| 01 | — | 208486 | GROUP PROVIDER NUMBER FOR THE GROUP NAMED: CHICAGO UPTOWN MEDICAL CENTER, GROU | IL |
| 01 | — | 787360 | MEDICARE GROUP PROV \# FOR GROUP NAMED: METROPOLITAN MEDICAL CONSULTANTS, S.C. | IL |