Basic Information
Provider Information | |||||||||
NPI: | 1669737474 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAUBER | ||||||||
FirstName: | KENDRA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MORLOK | ||||||||
OtherFirstName: | KENDRA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 29373 NETWORK PL | ||||||||
Address2: |   | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606731293 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8473905900 | ||||||||
FaxNumber: | 8473904757 | ||||||||
Practice Location | |||||||||
Address1: | 836 W WELLINGTON AVE | ||||||||
Address2: | ROOM 3604 | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606575147 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7732965435 | ||||||||
FaxNumber: | 7732967768 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/08/2012 | ||||||||
LastUpdateDate: | 06/23/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/23/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036137333 | IL | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208M00000X | 036137333 | IL | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
No ID Information.