Provider Demographics
NPI:1023260825
Name:RABY INSTITUTE FOR INTEGRATIVE MEDICINE AT NORTHWESTERN LLC
Entity type:Organization
Organization Name:RABY INSTITUTE FOR INTEGRATIVE MEDICINE AT NORTHWESTERN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THERI
Authorized Official - Middle Name:
Authorized Official - Last Name:RABY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-276-1212
Mailing Address - Street 1:PO BOX 11033
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-276-1212
Mailing Address - Fax:312-276-1213
Practice Address - Street 1:500 N MICHIGAN AVE STE 2100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3773
Practice Address - Country:US
Practice Address - Phone:312-276-1212
Practice Address - Fax:312-276-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091084174400000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF19524Medicare UPIN