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General NPI Number Information
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NPI Number | 1477850949
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Entity Type | Organization
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Legal Business Name | RAZON MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 3555 W PETERSON AVE 215
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City | CHICAGO
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State | IL
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Zip | 60659-3265
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Country | US
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Telephone | 773-267-2789
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Fax | 773-267-2804
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Provider Business Mailing Address
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Address Line | 3555 W PETERSON AVE 215
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City | CHICAGO
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State | IL
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Zip | 60659-3265
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Country | US
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Telephone | 773-267-2789
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Fax | 773-267-2804
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL A RAZON
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Credential | MD
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Telephone | 773-267-2789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036090053
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License Number State | IL
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