Provider Demographics
NPI:1437680402
Name:ROBERT A. RALEY DPM SC
Entity Type:Organization
Organization Name:ROBERT A. RALEY DPM SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-954-2243
Mailing Address - Street 1:70 MEADOWVIEW CTR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2047
Mailing Address - Country:US
Mailing Address - Phone:815-932-1724
Mailing Address - Fax:815-932-1729
Practice Address - Street 1:70 MEADOWVIEW CTR
Practice Address - Street 2:SUITE 401
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2047
Practice Address - Country:US
Practice Address - Phone:815-932-1724
Practice Address - Fax:815-932-1729
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1955
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003683213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty