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General NPI Number Information
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NPI Number | 1457681553
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Entity Type | Individual
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Provider Name | GABRIEL ANTHONY RAHHAL PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 777 PARK AVE W
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2433
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Country | US
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Telephone | 847-432-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 521 W BELMONT AVE # 1
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City | CHICAGO
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State | IL
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Zip | 60657-4610
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085.003628
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License Number State | IL
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