Healthcare Provider Details

I. General information

NPI: 1871809202
Provider Name (Legal Business Name): RAYA SAFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

600 N FAIRBANKS CT UNIT 2808
CHICAGO IL
60611-5861
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-8865
  • Fax: 312-227-9765
Mailing address:
  • Phone: 203-503-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301102266
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301102266
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4301102266
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036.140582
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: