Provider Demographics
NPI:1548399801
Name:RAPACZ, THEODORE
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:RAPACZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2159
Mailing Address - Country:US
Mailing Address - Phone:708-354-8250
Mailing Address - Fax:
Practice Address - Street 1:6555 NORTH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1059
Practice Address - Country:US
Practice Address - Phone:708-383-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X, 172P00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered172P00000XOther Service ProvidersNaprapath
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered