Provider Demographics
NPI:1326301482
Name:DR DONALD RADEN MD LLC
Entity Type:Organization
Organization Name:DR DONALD RADEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-377-2336
Mailing Address - Street 1:900 NORTH SHORE DR
Mailing Address - Street 2:STE 120
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2243
Mailing Address - Country:US
Mailing Address - Phone:855-377-2336
Mailing Address - Fax:847-615-1697
Practice Address - Street 1:900 NORTH SHORE DR
Practice Address - Street 2:STE 120
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2243
Practice Address - Country:US
Practice Address - Phone:855-377-2336
Practice Address - Fax:847-615-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361172252084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty