Healthcare Provider Details

I. General information

NPI: 1639375496
Provider Name (Legal Business Name): ANDREI MILAN RAKIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/29/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 GOLF ROAD
DES PLAINES IL
60616
US

IV. Provider business mailing address

9680 GOLF RD
DES PLAINES IL
60016-1522
US

V. Phone/Fax

Practice location:
  • Phone: 773-482-5800
  • Fax: 773-767-9604
Mailing address:
  • Phone: 773-482-5800
  • Fax: 773-767-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.121250
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036.121250
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: