Healthcare Provider Details

I. General information

NPI: 1295759033
Provider Name (Legal Business Name): JOHN MICHAEL RABA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S CALIFORNIA AVE
CHICAGO IL
60608-5107
US

IV. Provider business mailing address

301 N ELMWOOD AVE
OAK PARK IL
60302-2223
US

V. Phone/Fax

Practice location:
  • Phone: 773-869-7488
  • Fax: 773-869-7177
Mailing address:
  • Phone: 708-386-5217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36-54835
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: