Provider Demographics
NPI:1376743609
Name:JALAL RAIS DANA MD LTD
Entity Type:Organization
Organization Name:JALAL RAIS DANA MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIS DANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-296-6706
Mailing Address - Street 1:8780 W GOLF RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-296-6706
Mailing Address - Fax:847-759-1679
Practice Address - Street 1:8780 W GOLF RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-296-6706
Practice Address - Fax:847-759-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36090842208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty