Provider Demographics
NPI:1477114643
Name:RAIKOVSKII, EVGENII (MD)
Entity Type:Individual
Prefix:
First Name:EVGENII
Middle Name:
Last Name:RAIKOVSKII
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 1:2737 W EVERGREEN AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3098
Mailing Address - Country:US
Mailing Address - Phone:847-701-5118
Mailing Address - Fax:859-215-7827
Practice Address - Street 1:1324 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2161
Practice Address - Country:US
Practice Address - Phone:847-360-4303
Practice Address - Fax:847-596-4507
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.074759207R00000X
IL036.158203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine