Healthcare Provider Details

I. General information

NPI: 1215076708
Provider Name (Legal Business Name): DR DALE S RAINES & ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10837 S CICERO AVE SUITE 320
OAK LAWN IL
60453-6458
US

IV. Provider business mailing address

10837 S CICERO AVE SUITE 320
OAK LAWN IL
60453-6458
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-1601
  • Fax: 608-636-1825
Mailing address:
  • Phone: 708-636-1601
  • Fax: 608-636-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036056728
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT A RAINES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-636-1601