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NPI Code Detail

MEDICARE: RADIANT HEALTH CARE INC.

MEDICARE: RADIANT HEALTH CARE INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1689068926
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIANT HEALTH CARE INC.
Provider Business Mailing Address
First Line : 5757 N LINCOLN AVE
Second Line : SUITE 18
City : CHICAGO
State : IL
Zip : 60659-4714
Country : US
Telephone Number : 847-983-8356
Fax Number :
Provider Business Practice Location Address
First Line : 5757 N LINCOLN AVE
Second Line : SUITE 18
City : CHICAGO
State : IL
Zip : 60659-4714
Country : US
Telephone Number : 847-983-8356
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. LAURA RAVAGO
Credential :
Telephone Number : 847-983-8356
Provider Enumeration Date : 03/25/2015
Last Update Date : 03/25/2015

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