Healthcare Provider Details

I. General information

NPI: 1578827770
Provider Name (Legal Business Name): MICHAEL P RABINOWITZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 N SOUTHPORT AVE
CHICAGO IL
60613-4360
US

IV. Provider business mailing address

3701 N SOUTHPORT AVE
CHICAGO IL
60613-4360
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-4769
  • Fax:
Mailing address:
  • Phone: 773-472-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028979
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: