Provider Demographics
NPI:1124392964
Name:RTAIL, RAED ABDALLAH (SA-C, RSA)
Entity Type:Individual
Prefix:MR
First Name:RAED
Middle Name:ABDALLAH
Last Name:RTAIL
Suffix:
Gender:M
Credentials:SA-C, RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 N TALMAN AVE
Mailing Address - Street 2:FL. 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2721
Mailing Address - Country:US
Mailing Address - Phone:773-961-5548
Mailing Address - Fax:
Practice Address - Street 1:114 W ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2774
Practice Address - Country:US
Practice Address - Phone:847-353-8802
Practice Address - Fax:847-353-8812
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000322246ZC0007X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist