Provider Demographics
NPI:1508048414
Name:ROUEEN RAFEYAN MD LTD
Entity Type:Organization
Organization Name:ROUEEN RAFEYAN MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROUEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-433-0057
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-0258
Mailing Address - Country:US
Mailing Address - Phone:847-251-2067
Mailing Address - Fax:847-251-2104
Practice Address - Street 1:4455 S KING DR
Practice Address - Street 2:#101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3310
Practice Address - Country:US
Practice Address - Phone:847-251-2067
Practice Address - Fax:847-251-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360891522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210680Medicare PIN