Provider Demographics
NPI:1659387538
Name:RAY, ADRIENNE (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N MICHIGAN AVE
Mailing Address - Street 2:STE #210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3110
Mailing Address - Country:US
Mailing Address - Phone:312-670-2530
Mailing Address - Fax:312-670-2630
Practice Address - Street 1:625 N MICHIGAN AVE
Practice Address - Street 2:STE #210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3110
Practice Address - Country:US
Practice Address - Phone:312-670-2530
Practice Address - Fax:312-670-2630
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085007207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603891OtherBC/BS PROVIDER NUMBER
IL036085007Medicaid
IL1659387538OtherINDIVIDUAL NPI
IL1821211129OtherNPI GROUP NUMBER
IL036085007Medicaid
ILK06440Medicare PIN
IL208968Medicare PIN