Healthcare Provider Details

I. General information

NPI: 1336480078
Provider Name (Legal Business Name): SAMUEL F RABOR JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE ATTN: POSTDOCTORAL EDUCATION
OLYMPIA FIELDS IL
60461
US

IV. Provider business mailing address

1235 S PRAIRIE AVE #809
CHICAGO IL
60605-3403
US

V. Phone/Fax

Practice location:
  • Phone: 708-747-4000
  • Fax:
Mailing address:
  • Phone: 773-742-9851
  • 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 TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number67499-21
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.141055
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: