Healthcare Provider Details

I. General information

NPI: 1396243515
Provider Name (Legal Business Name): RACHEL ZAYAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FOXFIELD RD STE 102
ST CHARLES IL
60174-5799
US

IV. Provider business mailing address

3000 BAYSIDE DR UNIT 307
PALATINE IL
60074-3373
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-1188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085006484
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: