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General NPI Number Information
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NPI Number | 1821566977
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Entity Type | Organization
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Legal Business Name | RAPHAEL MEDICAL SERVICES CORP
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 6307 S STEWART AVE STE 306
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City | CHICAGO
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State | IL
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Zip | 60621-3116
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Country | US
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Telephone | 773-425-8665
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Fax | 773-776-8801
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Provider Business Mailing Address
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Address Line | 1516 FOWLER AVE
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City | EVANSTON
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State | IL
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Zip | 60201-3955
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Country | US
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Telephone | 737-776-8800
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Fax | 773-776-8801
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Authorized Official
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Title or Position | MD/MANAGER
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Name | DR. TADE AKERE
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Credential | M.D.
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Telephone | 773-776-8800
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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 |
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License Number State |
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