Provider Demographics
NPI:1902934532
Name:RAKOTZ, MICHAEL KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:RAKOTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1704 MAPLE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3134
Mailing Address - Country:US
Mailing Address - Phone:312-694-2010
Mailing Address - Fax:312-694-2020
Practice Address - Street 1:1704 MAPLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3134
Practice Address - Country:US
Practice Address - Phone:312-694-2010
Practice Address - Fax:312-694-2020
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01362441Medicaid
CO01362441Medicaid
CO46114-24KMedicare ID - Type UnspecifiedMEDICARE