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Organization
SAN PABLO MEDICAL CENTER, LTD.
Active
Organization
SAN PABLO MEDICAL CENTER, LTD.
Active
Other names
NORTH AVENUE PHYSICIANS CENTER, DIVISION PHYSICIANS CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
AMER RUSTUM M.D. (OWNER)
(773) 227-3500
Entity
Organization
Contact information
Practice address
2641 W DIVISION ST, CHICAGO, IL 60622-2851
(773) 227-3500
(773) 227-0432
Mailing address
2641 W DIVISION ST, CHICAGO, IL 60622-2851
(773) 227-3500
(773) 227-0432
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036083101
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00732012
BCBS
IL
01
—
DG4681
PALMETTO GBA
IL
Enumeration date
12/19/2006
Last updated
11/29/2012
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