MEDICARE: RACHEL MARIE WHITTAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	59860	KY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207P00000X	Emergency Medicine Physician	125.080693	IL

General Provider Information

NPI Number	:	1043956808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIE WHITTAKER

Provider Business Mailing Address
First Line	:	150 HARVESTER DR
Second Line	:	STE 300
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-6686
Country	:	US
Telephone Number	:	773-702-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE # MC5068
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1443
Country	:	US
Telephone Number	:	773-702-9109
Fax Number	:	773-702-3135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	01/13/2026

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