Healthcare Provider Details

I. General information

NPI: 1073179792
Provider Name (Legal Business Name): RAYYAN SAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 08/16/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2500
US

IV. Provider business mailing address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2500
US

V. Phone/Fax

Practice location:
  • Phone: 708-771-7000
  • Fax:
Mailing address:
  • Phone: 312-942-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.160025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: