Provider Demographics
NPI:1659587954
Name:MOHAMMAD A RAZZAQUE,MD,LTD
Entity Type:Organization
Organization Name:MOHAMMAD A RAZZAQUE,MD,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAZZAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-4800
Mailing Address - Street 1:3228 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:708-422-6534
Practice Address - Street 1:3228 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2314
Practice Address - Country:US
Practice Address - Phone:708-425-4800
Practice Address - Fax:708-422-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00036664OtherRAILROAD MEDICARE
IL211907Medicare PIN