Provider Demographics
NPI:1851420319
Name:RUSH UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:RUSH UNIVERSITY MEDICAL CENTER
Other - Org Name:RUSH ALZHEIMERS DISEASE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-563-2902
Mailing Address - Street 1:600 S PAULINA ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3806
Mailing Address - Country:US
Mailing Address - Phone:312-942-3333
Mailing Address - Fax:312-942-4154
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:SUITE 130
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-3333
Practice Address - Fax:312-942-4154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH UNIVERSITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01617418OtherBC GROUP
IL399480Medicare PIN