Razdan, Avtar K

Razdan, Avtar K is an sole proprietor health care provider with primary practice located at 475 Brown Blvd Suite 102, Bourbonnais IL 60914-2325. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Razdan, Avtar K can be contacted via phone (815) 939-0003.

Contact Information

Primary practice address
475 Brown Blvd Suite 102 Bourbonnais IL 60914-2325
Phone: (815) 939-0003
Fax: (815) 935-4908
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 036048822 Illinois

Profile Details

NPI number 1376536615
LBN Legal business name Razdan, Avtar K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 23rd, 2005
Last updated Sep 28th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376536615 NPPES
Illinois Other 04607499 BLUE CROSS BLUE SHIELD
Illinois MEDICAID 036048822 BLUE CROSS BLUE SHIELD

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