MEDICARE: DR. REBECCA S KEITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036113736	IL
2	207V00000X	Obstetrics & Gynecology Physician	036113736	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	036113736	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1104854785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA S KEITH MD

Provider Business Mailing Address
First Line	:	355 W NORTHWEST HWY
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-2414
Country	:	US
Telephone Number	:	847-221-4700
Fax Number	:	847-221-4796

Provider Business Practice Location Address
First Line	:	355 W NORTHWEST HWY
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-2414
Country	:	US
Telephone Number	:	847-221-4700
Fax Number	:	847-221-4796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/01/2021

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Directions to “ DR. REBECCA S KEITH MD” Practice Location

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