Provider Demographics
NPI:1700013166
Name:RAGHUVANSH KUMAR M D S C
Entity Type:Organization
Organization Name:RAGHUVANSH KUMAR M D S C
Other - Org Name:RAGHUVANSH KUMAR M D S C
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHUVANSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-307-2561
Mailing Address - Street 1:8161 RIDGEPOINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:630-655-8805
Mailing Address - Fax:630-655-8827
Practice Address - Street 1:20303 CRAWFORD AVE STE 120
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1173
Practice Address - Country:US
Practice Address - Phone:708-709-6929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099114208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099114Medicaid
IL709590Medicare PIN
IL036099114Medicaid