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Individual

DR. JOHN PAUL FEDERBUSCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2333 W IRVING PARK RD, CHICAGO, IL 60618
(773) 506-7340
(773) 506-7341
Mailing address
832 W OAKDALE AVE APT 3F, CHICAGO, IL 60657-5111
(630) 776-4923
(630) 629-3901

Taxonomy

Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
036056863
IL

Other

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
Enumeration date
03/13/2007
Last updated
07/29/2014
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