Individual
RAFIE DAVIDOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.N.-C.N.P.
Contact information
Practice address
800 BIESTERFIELD RD STE G01, WIMMER BUILDING, ELK GROVE VILLAGE, IL 60007-3372
(847) 981-3680
(847) 956-5122
Mailing address
900 S FRONTAGE RD, SUITE 325, WOODRIDGE, IL 60517-4903
(630) 972-8228
(630) 972-8229
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209014789
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720371669
GROUP PRACTICE NPI
IL
Enumeration date
11/11/2016
Last updated
11/11/2016
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