Healthcare Provider Details

I. General information

NPI: 1083750004
Provider Name (Legal Business Name): FRED DAVID RACHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W SUPERIOR ST
CHICAGO IL
60622-5646
US

IV. Provider business mailing address

3530 N LAKE SHORE DR #9B
CHICAGO IL
60657-1862
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-3494
  • Fax: 312-666-5867
Mailing address:
  • Phone: 773-935-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: