Provider Demographics
NPI:1760821839
Name:RUSTUM HEALTH NETWORK
Entity Type:Organization
Organization Name:RUSTUM HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-283-1802
Mailing Address - Street 1:PO BOX 220278
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-0278
Mailing Address - Country:US
Mailing Address - Phone:773-823-1802
Mailing Address - Fax:773-823-1814
Practice Address - Street 1:2827 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3513
Practice Address - Country:US
Practice Address - Phone:773-823-1802
Practice Address - Fax:773-823-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044669207Q00000X
IL036083101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty