Provider Demographics
NPI:1932326451
Name:RASTATTER, JEFF CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:CHARLES
Last Name:RASTATTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:225 E. CHICAGO AVE., #25
Mailing Address - Street 2:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2605
Mailing Address - Country:US
Mailing Address - Phone:312-227-6230
Mailing Address - Fax:312-227-9414
Practice Address - Street 1:225 E. CHICAGO AVE., #25
Practice Address - Street 2:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2605
Practice Address - Country:US
Practice Address - Phone:312-227-6230
Practice Address - Fax:312-227-9414
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2013-04-17
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Provider Licenses
StateLicense IDTaxonomies
IL036118993207YP0228X
OH35.088062207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-118993OtherLICENSE NUMBER
IL760060OtherMEDICARE GROUP PTAN
IL760060002OtherMEDICARE INDIVIDUAL PTAN