Provider Demographics
NPI:1316913890
Name:MONSON, REBECCA (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MONSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:(LUH. NORTH ENT., RM.7604)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-8757
Mailing Address - Fax:708-216-1259
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(LUH. NORTH ENT., RM.7604)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-8757
Practice Address - Fax:708-216-1259
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36103660207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36103660Medicaid
IL200417Medicare ID - Type Unspecified
IL36103660Medicaid
ILL89763Medicare ID - Type Unspecified