Individual
DR. GUADALUPE BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4007 W 63RD ST, CHICAGO, IL 60629-4605
(773) 767-2266
(773) 767-4380
Mailing address
4007 W 63RD ST, CHICAGO, IL 60629-4605
(773) 767-2266
(773) 767-3933
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036088384
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036088384
—
IL
Enumeration date
10/11/2005
Last updated
12/16/2010
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