Provider Demographics
NPI:1407939846
Name:DAFER, RIMA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RIMA
Middle Name:
Last Name:DAFER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1819
Mailing Address - Country:US
Mailing Address - Phone:708-524-8909
Mailing Address - Fax:
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(7005 W. NORTH AVE., OAK PRK, IL. 60302)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-2662
Practice Address - Fax:708-216-5617
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361146672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23221Medicare ID - Type Unspecified
A39905Medicare UPIN
ILK23222Medicare ID - Type Unspecified