Individual
JEFF CHARLES RASTATTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
225 E. CHICAGO AVE., #25, ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO, CHICAGO, IL 60611-2605
(312) 227-6230
(312) 227-9414
Mailing address
225 E. CHICAGO AVE., #25, ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO, CHICAGO, IL 60611-2605
(312) 227-6230
(312) 227-9414
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
036118993
IL
207YS0012X
Sleep Medicine (Otolaryngology) Physician
35.088062
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-118993
LICENSE NUMBER
IL
01
—
760060
MEDICARE GROUP PTAN
IL
01
—
760060002
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
04/18/2007
Last updated
04/17/2013
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