Provider Demographics
NPI:1518910389
Name:RAIDA, MICHAEL DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:RAIDA
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 1:211 E. ONTARIO ST.
Mailing Address - Street 2:SUITE 1195
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-640-7732
Mailing Address - Fax:312-988-9363
Practice Address - Street 1:211 E. ONTARIO ST.
Practice Address - Street 2:SUITE 1195
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-640-7732
Practice Address - Fax:312-988-9363
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1129812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112981Medicaid
ILI55626Medicare UPIN
I55626Medicare UPIN
IL036112981Medicaid