Provider Demographics
NPI:1992864102
Name:CLAVERIA, RAFAEL MACARANAS (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:MACARANAS
Last Name:CLAVERIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W DIVISION ST STE 355
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2996
Mailing Address - Country:US
Mailing Address - Phone:773-342-3665
Mailing Address - Fax:773-343-3606
Practice Address - Street 1:2222 W DIVISION ST STE 355
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2996
Practice Address - Country:US
Practice Address - Phone:773-342-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC46141Medicare UPIN
IL731820Medicare ID - Type Unspecified