Provider Demographics
NPI:1477850949
Name:RAZON MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:RAZON MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-267-2789
Mailing Address - Street 1:3555 W PETERSON AVE
Mailing Address - Street 2:215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3265
Mailing Address - Country:US
Mailing Address - Phone:773-267-2789
Mailing Address - Fax:773-267-2804
Practice Address - Street 1:3555 W PETERSON AVE
Practice Address - Street 2:215
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3265
Practice Address - Country:US
Practice Address - Phone:773-267-2789
Practice Address - Fax:773-267-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty