Healthcare Provider Details

I. General information

NPI: 1255750279
Provider Name (Legal Business Name): REBECCA C OBENG MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 7-132N
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST STE 7-132N
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-7180
  • Fax: 312-926-3127
Mailing address:
  • Phone: 312-926-7180
  • Fax: 312-926-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036152564
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: