Provider Demographics
NPI:1841531456
Name:RUSH OAK PARK PHYSICIANS GROUP LAKE STREET
Entity type:Organization
Organization Name:RUSH OAK PARK PHYSICIANS GROUP LAKE STREET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-942-7770
Mailing Address - Street 1:1011 LAKE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1148
Mailing Address - Country:US
Mailing Address - Phone:708-628-0600
Mailing Address - Fax:
Practice Address - Street 1:1011 LAKE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1148
Practice Address - Country:US
Practice Address - Phone:708-628-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-06
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty