Healthcare Provider Details

I. General information

NPI: 1750376869
Provider Name (Legal Business Name): EVALDAS RADZEVICIUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date: 03/23/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

14315 108TH AVE STE 215
ORLAND PARK IL
60467-5701
US

IV. Provider business mailing address

14315 108TH AVE STE 215
ORLAND PARK IL
60467-5701
US

V. Phone/Fax

Practice location:
  • Phone: 708-966-0993
  • Fax: 708-966-0997
Mailing address:
  • Phone: 708-966-0993
  • Fax: 708-966-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number24217
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036126035
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: