Healthcare Provider Details

I. General information

NPI: 1265479422
Provider Name (Legal Business Name): DR. MICHAEL K RAYMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD 1900
SKOKIE IL
60076-1234
US

IV. Provider business mailing address

9650 GROSS POINT RD 1900
SKOKIE IL
60076-1234
US

V. Phone/Fax

Practice location:
  • Phone: 847-676-1112
  • Fax: 847-674-3358
Mailing address:
  • Phone: 847-676-1112
  • Fax: 847-674-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036067244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: