Provider Demographics
NPI:1972760411
Name:RANCHERO, REBEKAH R (DO)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:R
Last Name:RANCHERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W DEMPSTER ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1109
Mailing Address - Country:US
Mailing Address - Phone:847-299-7888
Mailing Address - Fax:847-299-7844
Practice Address - Street 1:1600 W DEMPSTER ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1109
Practice Address - Country:US
Practice Address - Phone:847-299-7888
Practice Address - Fax:847-299-7844
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5273002Medicare PIN
ILIL5273Medicare PIN