Provider Demographics
NPI:1760470314
Name:RAZZAQ, ABDUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:
Last Name:RAZZAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 S VILLA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-832-9000
Mailing Address - Fax:630-832-7907
Practice Address - Street 1:33 S VILLA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-832-9000
Practice Address - Fax:630-832-7907
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 042083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042083Medicaid
C390005Medicare UPIN
IL301950Medicare ID - Type Unspecified