# FULLERTON SURGERY CENTER LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FULLERTON SURGERY CENTER INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285675678
- **Authorized official:** NASER RUSTOM M.D. (OWNER/MEDICAL DIRECTOR)
- **Authorized official phone:** (773) 237-2900

## Contact information

- **Practice address:** 4849 W FULLERTON AVE, CHICAGO, IL 60639-2503
- **Practice address phone:** (773) 237-2900
- **Practice address fax:** (773) 622-0769
- **Mailing address:** 4849 W FULLERTON AVE, CHICAGO, IL 60639-2503
- **Mailing address phone:** (773) 237-2900
- **Mailing address fax:** (773) 622-0769

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 042618689 | IL | Yes |

## Other

- **Enumeration date:** 06/09/2006
- **Last updated:** 02/06/2018