Basic Information
| Provider Information | |||||||||
| NPI: | 1861513269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYUSTE | ||||||||
| FirstName: | HERMES | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 SAINT STEPHENS GRN | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605232569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307896738 | ||||||||
| FaxNumber: | 6309718842 | ||||||||
| Practice Location | |||||||||
| Address1: | 2233 WEST DIVISION ST | ||||||||
| Address2: | ST MARY AND ELIZABETH MEDICAL CENTER | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127702000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.