Provider Demographics
NPI:1104854785
Name:KEITH, REBECCA S (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:355 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2414
Mailing Address - Country:US
Mailing Address - Phone:847-221-4700
Mailing Address - Fax:847-221-4796
Practice Address - Street 1:355 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2414
Practice Address - Country:US
Practice Address - Phone:847-221-4700
Practice Address - Fax:847-221-4796
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113736174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361137361Medicaid
IL036113736OtherSTATE LICENSE