Provider Demographics
NPI:1568567030
Name:DELBUSTO, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DELBUSTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-423-1130
Mailing Address - Fax:708-423-3610
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-423-1130
Practice Address - Fax:708-423-3610
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083298207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632140OtherBCBS
IL036083298Medicaid
IL66003637OtherRR MEDICARE
ILL99475Medicare ID - Type Unspecified
ILF71829Medicare UPIN