Provider Demographics
NPI:1538108550
Name:ROLAND S MEDANSKY & RAYMOND M HANDLER
Entity Type:Organization
Organization Name:ROLAND S MEDANSKY & RAYMOND M HANDLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-299-1044
Mailing Address - Street 1:8780 W GOLF RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5602
Mailing Address - Country:US
Mailing Address - Phone:847-299-1044
Mailing Address - Fax:847-299-0425
Practice Address - Street 1:8780 W GOLF RD
Practice Address - Street 2:SUITE 303
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5602
Practice Address - Country:US
Practice Address - Phone:847-299-1044
Practice Address - Fax:847-299-0425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROLAND S MEDANSKY & RAYMOND M HANDLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0163954584OtherCHICAGO BLUE CROSS
IL216-00658-36OtherNILES BLUE CROSS
IL2162065856OtherCHICAGO BLUE CROSS
IL0162954574OtherNILES BLUE CROSS
ILME441341Medicare ID - Type Unspecified
ILME441340Medicare ID - Type Unspecified
ILHA454070Medicare ID - Type Unspecified
ILHA454071Medicare ID - Type Unspecified