Provider Demographics
NPI:1720529001
Name:RACHEL A. WINTERS M.D.
Entity Type:Organization
Organization Name:RACHEL A. WINTERS M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-943-6202
Mailing Address - Street 1:2111 LEXINGTON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-2085
Mailing Address - Country:US
Mailing Address - Phone:618-943-6202
Mailing Address - Fax:
Practice Address - Street 1:2111 LEXINGTON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2085
Practice Address - Country:US
Practice Address - Phone:618-943-6202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL538822373Medicaid
IL538822373Medicaid