MEDICARE: DR. ASAD REDJAI M.D.

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
1	207RC0000X	Cardiovascular Disease Physician	036053488	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851351639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASAD REDJAI M.D.

Provider Business Mailing Address
First Line	:	1945 W WILSON AVE
Second Line	:	SUITE 6120
City	:	CHICAGO
State	:	IL
Zip	:	60640-5255
Country	:	US
Telephone Number	:	773-784-5300
Fax Number	:	773-784-5391

Provider Business Practice Location Address
First Line	:	1945 W WILSON AVE
Second Line	:	SUITE 6120
City	:	CHICAGO
State	:	IL
Zip	:	60640-5255
Country	:	US
Telephone Number	:	773-784-5300
Fax Number	:	773-784-5391

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	12/01/2010

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