Provider Demographics
NPI:1093962763
Name:METS-HALGRIMSON, REBECCA B (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:B
Last Name:METS-HALGRIMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:B
Other - Last Name:METS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:BOX 70
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6717
Mailing Address - Fax:312-227-9411
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX 70
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6717
Practice Address - Fax:312-227-9411
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051884207W00000X
CO50435207W00000X
DCMD038581207W00000X
MDM69980207W00000X
VA0101247246207W00000X
IL036134113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50536265Medicaid
COCOAAA13258Medicare PIN