Provider Demographics
NPI:1861513269
Name:AYUSTE, HERMES (MD)
Entity type:Individual
Prefix:
First Name:HERMES
Middle Name:
Last Name:AYUSTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SAINT STEPHENS GRN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2569
Mailing Address - Country:US
Mailing Address - Phone:630-789-6738
Mailing Address - Fax:630-971-8842
Practice Address - Street 1:2233 WEST DIVISION ST
Practice Address - Street 2:ST MARY AND ELIZABETH MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:312-770-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology