Provider Demographics
NPI:1518441344
Name:KENNETH RASKIN MD ILLINOIS SC
Entity Type:Organization
Organization Name:KENNETH RASKIN MD ILLINOIS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-994-1818
Mailing Address - Street 1:5790 STEFANIE WAY
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53108-9561
Mailing Address - Country:US
Mailing Address - Phone:262-994-1818
Mailing Address - Fax:262-317-9311
Practice Address - Street 1:1827 WALDEN OFFICE SQ STE 250
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4344
Practice Address - Country:US
Practice Address - Phone:847-258-7148
Practice Address - Fax:312-488-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty