Provider Demographics
NPI:1902884273
Name:WINTERS, RACHEL ANN (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2111 LEXINGTON AVE
Mailing Address - Street 2:
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:618-943-3611
Practice Address - Street 1:2111 LEXINGTON AVE
Practice Address - Street 2:
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:618-943-3611
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1412697OtherUNITED HEALTHCARE
080089176OtherRAILROAD MEDICARE
255938OtherHEALTHLINK
L040796OtherTRICARE
IL050107409OtherBLUE CROSS BLUE SHIELD
057693OtherHEALTH ALLIANCE
565630OtherAENTA
IL050107409OtherBLUE CROSS BLUE SHIELD
F68454Medicare UPIN
565630OtherAENTA