Provider Demographics
NPI:1265479422
Name:RAYMOND, MICHAEL K
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD
Mailing Address - Street 2:1900
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1234
Mailing Address - Country:US
Mailing Address - Phone:847-676-1112
Mailing Address - Fax:847-674-3358
Practice Address - Street 1:9650 GROSS POINT RD
Practice Address - Street 2:1900
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1234
Practice Address - Country:US
Practice Address - Phone:847-676-1112
Practice Address - Fax:847-674-3358
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067244Medicaid
ILD15694Medicare UPIN