Provider Demographics
NPI:1689068926
Name:RADIANT HEALTH CARE INC.
Entity Type:Organization
Organization Name:RADIANT HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-983-8356
Mailing Address - Street 1:5757 N LINCOLN AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4714
Mailing Address - Country:US
Mailing Address - Phone:847-983-8356
Mailing Address - Fax:
Practice Address - Street 1:5757 N LINCOLN AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4714
Practice Address - Country:US
Practice Address - Phone:847-983-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty