Provider Demographics
NPI:1760452825
Name:HART, RITA (DO)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:MATHEWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:25259 S REED ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-6003
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-9128
Practice Address - Street 1:27240 W SAXONY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-1415
Practice Address - Country:US
Practice Address - Phone:815-467-1518
Practice Address - Fax:815-467-7419
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081480208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081480-1Medicaid
ILE82088Medicare UPIN