Provider Demographics
NPI:1013146596
Name:OSGOOD, REBEKAH (MD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:OSGOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR STE 810
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8700
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-587-9802
Practice Address - Street 1:680 N LAKE SHORE DR STE 810
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8700
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-587-9802
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132078207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125055889OtherTEMPORARY LICENSE NUMBER