Healthcare Provider Details

I. General information

NPI: 1467370452
Provider Name (Legal Business Name): REHAM KAUSAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE
CHICAGO IL
60649-3954
US

IV. Provider business mailing address

212 W DIVERSEY AVE
ADDISON IL
60101-3507
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7309
  • Fax:
Mailing address:
  • Phone: 773-947-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number089037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: