Healthcare Provider Details

I. General information

NPI: 1326058736
Provider Name (Legal Business Name): RAYNA MERLE JOSEPH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 N CLYBOURN AVE
CHICAGO IL
60610-2089
US

IV. Provider business mailing address

1276 N CLYBOURN AVE
CHICAGO IL
60610-2089
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-1073
  • Fax: 312-337-7616
Mailing address:
  • Phone: 312-337-1073
  • Fax: 312-337-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-096298
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036096298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: