MEDICARE: DR. RACHEL A SACCARO D.O.

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	208000000X	Pediatrics Physician	036.126004	IL

General Provider Information

NPI Number	:	1821244328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL A SACCARO D.O.

Provider Business Mailing Address
First Line	:	4820 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3212
Country	:	US
Telephone Number	:	773-545-2525
Fax Number	:	773-205-5700

Provider Business Practice Location Address
First Line	:	4820 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3212
Country	:	US
Telephone Number	:	773-545-2525
Fax Number	:	773-205-5700

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

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	07/28/2010

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