Provider Demographics
NPI:1538137831
Name:RAGER, JEFFREY J (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:RAGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 GROSS POINT RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1356
Mailing Address - Country:US
Mailing Address - Phone:847-679-3411
Mailing Address - Fax:847-675-7450
Practice Address - Street 1:9555 GROSS POINT RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1356
Practice Address - Country:US
Practice Address - Phone:847-679-3411
Practice Address - Fax:847-675-7450
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005125213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005125OtherLICENSE
IL01634664OtherBLUE CROSS BLUE SHIELD NU
IL210776OtherMEDICARE NUMBER
IL5347420001Medicare NSC
ILK11138Medicare PIN
ILU99735Medicare UPIN