=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851351639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASAD REDJAI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2006
-----------------------------------------------------
Last Update Date | 12/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1945 W WILSON AVE SUITE 6120
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60640-5255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-784-5300
-----------------------------------------------------
Fax | 773-784-5391
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1945 W WILSON AVE SUITE 6120
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60640-5255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-784-5300
-----------------------------------------------------
Fax | 773-784-5391
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 036053488
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------