Provider Demographics
NPI:1184683849
Name:RAZZAQUE, MOHAMMAD ABDUR (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ABDUR
Last Name:RAZZAQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2314
Mailing Address - Country:US
Mailing Address - Phone:708-425-4800
Mailing Address - Fax:708-422-6534
Practice Address - Street 1:3228 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2314
Practice Address - Country:US
Practice Address - Phone:708-425-4800
Practice Address - Fax:708-422-6534
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110214505OtherRAILROAD MEDICARE
IL036089799Medicaid
IL1622853OtherBCBS
IL1622853OtherBCBS
ILK18731Medicare PIN