Individual
PAUL MICHAEL DE BUSTROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11516 183RD PL STE SE, ORLAND PARK, IL 60467-9456
(708) 915-6807
Mailing address
450 E WATERSIDE DR UNIT 2808, CHICAGO, IL 60601-4730
(708) 567-8890
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036.169593
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
036.169593
IL
Other
Enumeration date
03/24/2021
Last updated
06/30/2025
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