MEDICARE: DR. MICHAEL KEVIN RAKOTZ 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	207Q00000X	Family Medicine Physician	036117580	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

General Provider Information

NPI Number	:	1902934532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KEVIN RAKOTZ MD

Provider Business Mailing Address
First Line	:	1704 MAPLE AVE
Second Line	:	SUITE 200
City	:	EVANSTON
State	:	IL
Zip	:	60201-3134
Country	:	US
Telephone Number	:	312-694-2010
Fax Number	:	312-694-2020

Provider Business Practice Location Address
First Line	:	1704 MAPLE AVE
Second Line	:	SUITE 200
City	:	EVANSTON
State	:	IL
Zip	:	60201-3134
Country	:	US
Telephone Number	:	312-694-2010
Fax Number	:	312-694-2020

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/26/2013

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