Healthcare Provider Details

I. General information

NPI: 1518228170
Provider Name (Legal Business Name): JAIME REBECCA OBSZANSKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21481 N RAND RD
KILDEER IL
60047-3061
US

IV. Provider business mailing address

21481 N RAND RD
KILDEER IL
60047-3061
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-9655
  • Fax: 847-618-9654
Mailing address:
  • Phone: 847-618-9655
  • Fax: 847-618-9654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.061102
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036149324
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: