1750376869 NPI number — DR. EVALDAS RADZEVICIUS MD

Table of content: DR. EVALDAS RADZEVICIUS MD (NPI 1750376869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750376869 NPI number — DR. EVALDAS RADZEVICIUS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADZEVICIUS
Provider First Name:
EVALDAS
Provider Middle Name:
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:
1750376869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14315 108TH AVE
Provider Second Line Business Mailing Address:
STE 215
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60467-5701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-966-0993
Provider Business Mailing Address Fax Number:
708-966-0997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14315 108TH AVE
Provider Second Line Business Practice Location Address:
STE 215
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60467-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-966-0993
Provider Business Practice Location Address Fax Number:
708-966-0997
Provider Enumeration Date:
09/14/2005

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: 103TF0000X , with the licence number:  24217 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 036126035 , 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: 009984865 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00358766 . This is a "MEDICARE ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 036126035 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: K377 . This is a "MEDICARE GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com