Provider Demographics
NPI:1689809808
Name:REBUCK, DAVID AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AARON
Last Name:REBUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:350 S NORTHWEST HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4262
Mailing Address - Country:US
Mailing Address - Phone:847-470-1500
Mailing Address - Fax:847-470-1550
Practice Address - Street 1:350 S NORTHWEST HWY STE 106
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4262
Practice Address - Country:US
Practice Address - Phone:847-470-1500
Practice Address - Fax:847-470-1550
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122111208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122111Medicaid
5514060005Medicare NSC
F400183458Medicare PIN