Provider Demographics
NPI:1942634837
Name:SAAVEDRA, RENAN
Entity Type:Individual
Prefix:
First Name:RENAN
Middle Name:
Last Name:SAAVEDRA
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 1:9650 GROSS POINT RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5080
Mailing Address - Country:US
Mailing Address - Phone:847-866-7846
Mailing Address - Fax:866-954-5815
Practice Address - Street 1:9650 GROSS POINT RD.
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3187-23363A00000X
FLPA9108184363A00000X
CAPA56810363A00000X
IL085.007274363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant