Healthcare Provider Details

I. General information

NPI: 1467136127
Provider Name (Legal Business Name): RADEN MEDICAL CHI, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 N CLYBOURN AVE STE 101
CHICAGO IL
60614-4903
US

IV. Provider business mailing address

1915 N CLYBOURN AVE STE 101
CHICAGO IL
60614-4903
US

V. Phone/Fax

Practice location:
  • Phone: 773-598-6995
  • Fax:
Mailing address:
  • Phone: 773-598-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON OSTBY
Title or Position: CLINIC & OPERATIONS DIRECTOR
Credential:
Phone: 847-235-2139