Healthcare Provider Details

I. General information

NPI: 1104459668
Provider Name (Legal Business Name): REBEKKA AYELET FEINGOLD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E SUPERIOR ST STE 5-2261
CHICAGO IL
60611-2914
US

IV. Provider business mailing address

250 E SUPERIOR ST STE 5-2261
CHICAGO IL
60611-2914
US

V. Phone/Fax

Practice location:
  • Phone: 866-587-4322
  • Fax: 312-472-5767
Mailing address:
  • Phone: 866-587-4322
  • Fax: 312-472-5767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: