Provider Demographics
NPI:1134159825
Name:GUSTIN, ALLEN N JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:N
Last Name:GUSTIN
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY, LOYOLA UNIVERSITY
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:773-294-4355
Mailing Address - Fax:773-294-4355
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY, LOYOLA
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:773-294-4355
Practice Address - Fax:773-294-4355
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0055948207L00000X
AL0021357207L00000X
IL036124344207LC0200X, 207LH0002X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA501700402EMedicaid
GA05BDKRTMedicare ID - Type Unspecified
GA501700402EMedicaid