Provider Demographics
NPI:1154374171
Name:RUSTOM, NASER (MD)
Entity type:Individual
Prefix:DR
First Name:NASER
Middle Name:
Last Name:RUSTOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NASER
Other - Middle Name:
Other - Last Name:RUSTOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4941 N KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5009
Mailing Address - Country:US
Mailing Address - Phone:773-509-9099
Mailing Address - Fax:773-509-9006
Practice Address - Street 1:4941 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5009
Practice Address - Country:US
Practice Address - Phone:773-509-9099
Practice Address - Fax:773-509-9006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBR2928642OtherDEA
ILBR2928642OtherDEA
IL536800Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
F43791Medicare UPIN