Healthcare Provider Details

I. General information

NPI: 1730244237
Provider Name (Legal Business Name): RACHEL LYNNE BAUGUES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 10/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

IV. Provider business mailing address

1531 N BELL AVE
CHICAGO IL
60622-1834
US

V. Phone/Fax

Practice location:
  • Phone: 708-493-0299
  • Fax:
Mailing address:
  • Phone: 773-895-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002909
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: