Individual
SERGE N DEBUSTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
71 W 156TH ST, SUITE 400, HARVEY, IL 60426-4265
(708) 596-8710
(708) 596-9820
Mailing address
11516 183RD PL STE SW, ORLAND PARK, IL 60467-9471
(708) 877-1300
(708) 596-8719
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036081438
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
01038973A
IN
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
036081438
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036081438
—
IL
01
—
180012658
RRMC
IN
01
—
180015436
RRMC
IL
Enumeration date
07/22/2005
Last updated
02/04/2022
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