1265413454 NPI number — DR. ANTANAS G RAZMA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265413454 NPI number — DR. ANTANAS G RAZMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAZMA
Provider First Name:
ANTANAS
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265413454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 E OGDEN AVE STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-5554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-871-5737
Provider Business Mailing Address Fax Number:
630-522-0843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11900 SOUTHWEST HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOS PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60464-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-274-4900
Provider Business Practice Location Address Fax Number:
708-274-4949
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  036066208 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 036066208 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 290003183 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036066208 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com