Provider Demographics
NPI:1861766404
Name:ASAD REDJAI MD SC
Entity type:Organization
Organization Name:ASAD REDJAI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:REDJAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD SC
Authorized Official - Phone:773-784-5300
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE 6120
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-784-5300
Mailing Address - Fax:773-784-5391
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 6120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-784-5300
Practice Address - Fax:773-784-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053488261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053488Medicaid
IL036053488Medicaid