Healthcare Provider Details

I. General information

NPI: 1942203500
Provider Name (Legal Business Name): RAYMOND J MCDONALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 JACKSON AVE
RIVER FOREST IL
60305-1804
US

IV. Provider business mailing address

2010 N HARLEM AVE
ELMWOOD PARK IL
60707-3119
US

V. Phone/Fax

Practice location:
  • Phone: 708-343-0079
  • Fax:
Mailing address:
  • Phone: 708-452-1111
  • Fax: 708-452-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036045872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: