Healthcare Provider Details

I. General information

NPI: 1669442174
Provider Name (Legal Business Name): RACHEL BOOTH LEWIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SHERIDAN PL
EVANSTON IL
60201-1725
US

IV. Provider business mailing address

2801 SHERIDAN PL
EVANSTON IL
60201-1725
US

V. Phone/Fax

Practice location:
  • Phone: 619-829-8809
  • Fax:
Mailing address:
  • Phone: 619-829-8809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number036129836
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: