Healthcare Provider Details

I. General information

NPI: 1114581584
Provider Name (Legal Business Name): REBECCA CLARE WORNHOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 08/08/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 S CALIFORNIA AVE
CHICAGO IL
60632-2016
US

IV. Provider business mailing address

4720 S CALIFORNIA AVE
CHICAGO IL
60632-2016
US

V. Phone/Fax

Practice location:
  • Phone: 773-584-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036171253
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number289484
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: