Provider Demographics
NPI:1154448355
Name:RUSH PRES ST. LUKE'S MED CENTER
Entity type:Organization
Organization Name:RUSH PRES ST. LUKE'S MED CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:4711 GOLF RD STE 711
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1245
Mailing Address - Country:US
Mailing Address - Phone:847-568-9911
Mailing Address - Fax:847-568-9912
Practice Address - Street 1:4711 GOLF RD STE 711
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1245
Practice Address - Country:US
Practice Address - Phone:847-568-9911
Practice Address - Fax:847-568-9912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH PRES ST. LUKE'S MED CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-23
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL267870Medicare ID - Type UnspecifiedGROUP