Healthcare Provider Details

I. General information

NPI: 1083632384
Provider Name (Legal Business Name): DONALD R. RADEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GREEN BAY RD STE 200
HIGHWOOD IL
60040-1703
US

IV. Provider business mailing address

200 GREEN BAY RD STE 200
HIGHWOOD IL
60040-1703
US

V. Phone/Fax

Practice location:
  • Phone: 847-235-2139
  • Fax:
Mailing address:
  • Phone: 847-235-2139
  • Fax: 847-615-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036-117225
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: