Healthcare Provider Details

I. General information

NPI: 1982710828
Provider Name (Legal Business Name): MAREK B REBANDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N LINCOLN AVE SUITE #4
CHICAGO IL
60614-7170
US

IV. Provider business mailing address

2202 N LINCOLN AVE SUITE #4
CHICAGO IL
60614-7170
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-3444
  • Fax: 773-871-7906
Mailing address:
  • Phone: 773-871-3444
  • Fax: 773-871-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: