Provider Demographics
NPI:1841560141
Name:RUSH OAK PARK PHYSICIANS GROUP CENTER FOR DIABETES AND ENDOCRINE
Entity Type:Organization
Organization Name:RUSH OAK PARK PHYSICIANS GROUP CENTER FOR DIABETES AND ENDOCRINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-942-7770
Mailing Address - Street 1:520 S MAPLE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1022
Mailing Address - Country:US
Mailing Address - Phone:708-660-5900
Mailing Address - Fax:
Practice Address - Street 1:520 S MAPLE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1022
Practice Address - Country:US
Practice Address - Phone:708-660-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH OAK PARK HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-04
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty