Healthcare Provider Details

I. General information

NPI: 1942634837
Provider Name (Legal Business Name): RENAN SAAVEDRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD.
EVANSTON IL
60201
US

IV. Provider business mailing address

9650 GROSS POINT RD
SKOKIE IL
60076-5080
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-7846
  • Fax:
Mailing address:
  • Phone: 847-866-7846
  • Fax: 866-954-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3187-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108184
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56810
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.007274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: