Provider Demographics
NPI:1821566977
Name:RAPHAEL MEDICAL SERVICES CORP
Entity Type:Organization
Organization Name:RAPHAEL MEDICAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TADE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-776-8800
Mailing Address - Street 1:1516 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3955
Mailing Address - Country:US
Mailing Address - Phone:737-776-8800
Mailing Address - Fax:773-776-8801
Practice Address - Street 1:6307 S STEWART AVE STE 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:773-425-8665
Practice Address - Fax:773-776-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094343Medicaid