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4849 W Fullerton Ave, Chicago, IL 60639-2503 | |
(773) 309-6740 | |
(773) 237-6606 |
Full Name | |
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Type | Facility |
Speciality | Family Medicine |
Location | 4849 W Fullerton Ave, Chicago, Illinois |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1497797393 | NPI | - | NPPES |
Provider Name | Naser Rustom |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1154374171 PECOS PAC ID: 6002719556 Enrollment ID: I20040414000215 |
Provider Name | Juanita Moreno Valverde |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1922258276 PECOS PAC ID: 9234290560 Enrollment ID: I20081205000093 |
Provider Name | Maurice A Guzman |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1528057874 PECOS PAC ID: 9739350703 Enrollment ID: I20110922000709 |
Mailing Address | Practice Location Address |
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4903 W Fullerton Ave, Chicago, IL 60639-2548 Ph: (773) 237-0755 | 4849 W Fullerton Ave, Chicago, IL 60639-2503 Ph: (773) 309-6740 |