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General NPI Number Information
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NPI Number | 1104338516
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Entity Type | Organization
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Legal Business Name | RAFATI FOOT AND ANKLE CLINIC LLC
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 7604 W 63RD ST
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City | SUMMIT
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State | IL
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Zip | 60501-1812
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Country | US
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Telephone | 219-688-6292
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Fax |
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Provider Business Mailing Address
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Address Line | 9340 LOCHWOOD PL
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City | TINLEY PARK
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State | IL
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Zip | 60487-4797
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Country | US
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Telephone | 219-688-6292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MURAD ABDEL-QADER
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Credential |
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Telephone | 219-688-6292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005230
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016005230
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License Number State | IL
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