Healthcare Provider Details

I. General information

NPI: 1821244328
Provider Name (Legal Business Name): RACHEL A SACCARO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 N CENTRAL AVE
CHICAGO IL
60630-3212
US

IV. Provider business mailing address

4820 N CENTRAL AVE
CHICAGO IL
60630-3212
US

V. Phone/Fax

Practice location:
  • Phone: 773-545-2525
  • Fax: 773-205-5700
Mailing address:
  • Phone: 773-545-2525
  • Fax: 773-205-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.126004
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: