Galilee Medical Center S.C.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

042-616-998 Issued in IL

Legal business name

GALILEE MEDICAL CENTER S.C.

Practice address

4941 N. Kedzie Ave
Chicago, IL 60625

Phone

(773) 509-9099

Fax

(773) 509-9006

NPI assigned

May 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Naser Rustom, M.D.

Title

Owner

Phone

(773) 561-9100

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Galilee Medical Center SC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Galilee Medical Center, S.C.

  • Clinical Medical Laboratory
  • Chicago, IL
  • NPI 1497493241
  NPD tax ID
• Galilee Medical Center, S.C.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1497797393
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236124800000",
    "number": "1437104239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4941 N. KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60625",
            "telephone_number": "773-509-9099",
            "fax_number": "773-509-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4941 N. KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60625",
            "telephone_number": "773-509-9099",
            "fax_number": "773-509-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALILEE MEDICAL CENTER S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2009-03-04",
        "status": "A",
        "authorized_official_last_name": "RUSTOM",
        "authorized_official_first_name": "NASER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-561-9100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "IL",
            "license": "042-616-998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILL",
            "identifier": "31604553",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerson Gamaliel Galicia Perez, RPH
• Iris Galicia
• Samantha Galicia, ATC
• Sandra A. Galicia, LCSW
• Melissa Galick
• Galilee Medical Center, S.C.
• Galilee Medical Center, S.C.
• Galilee Medical Center, S.C.
• Galilee Medical Center, S.C.
• Galilee Medical Center, S.C.

• General Practice Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.