Provider Demographics
NPI:1699198929
Name:RIFAI M.D.,S.C.
Entity Type:Organization
Organization Name:RIFAI M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALRIFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-583-7520
Mailing Address - Street 1:4708 N KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4421
Mailing Address - Country:US
Mailing Address - Phone:773-583-7520
Mailing Address - Fax:
Practice Address - Street 1:4708 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4421
Practice Address - Country:US
Practice Address - Phone:773-583-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056607302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization