Provider Demographics
NPI:1356438436
Name:RAPPAPORT, JESSICA SARA (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SARA
Last Name:RAPPAPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:570 LINCOLN AVE
Mailing Address - Street 2:SUITE1
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2355
Mailing Address - Country:US
Mailing Address - Phone:224-255-6001
Mailing Address - Fax:224-255-6709
Practice Address - Street 1:570 LINCOLN AVE
Practice Address - Street 2:SUITE1
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2355
Practice Address - Country:US
Practice Address - Phone:224-255-6001
Practice Address - Fax:224-255-6709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2015-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.126634208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02604259Medicaid
NY02604259Medicaid
NYH78082Medicare UPIN