Provider Demographics
NPI:1457360703
Name:RUSH UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:RUSH UNIVERSITY MEDICAL CENTER
Other - Org Name:DERMATOLOGY PATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-5000
Mailing Address - Street 1:1725 W HARRISON ST STE 264
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3844
Mailing Address - Country:US
Mailing Address - Phone:312-942-2195
Mailing Address - Fax:312-563-2263
Practice Address - Street 1:1725 W HARRISON ST STE 264
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3844
Practice Address - Country:US
Practice Address - Phone:312-942-2195
Practice Address - Fax:312-563-2263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH UNIVERSITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
267870Medicare ID - Type Unspecified