Healthcare Provider Details

I. General information

NPI: 1134759731
Provider Name (Legal Business Name): RACHEL RUZEVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9570 W 159TH ST
ORLAND PARK IL
60467-5504
US

IV. Provider business mailing address

17548 OLIVIA LN
ORLAND PARK IL
60467-9367
US

V. Phone/Fax

Practice location:
  • Phone: 708-675-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.007533
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: