1508048414 NPI number — ROUEEN RAFEYAN MD LTD

Table of content: (NPI 1508048414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508048414 NPI number — ROUEEN RAFEYAN MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROUEEN RAFEYAN MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1508048414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 258
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENILWORTH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60043-0258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-251-2067
Provider Business Mailing Address Fax Number:
847-251-2104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4455 S KING DR
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60653-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-251-2067
Provider Business Practice Location Address Fax Number:
847-251-2104
Provider Enumeration Date:
12/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAFEYAN
Authorized Official First Name:
ROUEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-433-0057

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  036089152 , 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)