Provider Demographics
NPI:1851351639
Name:REDJAI, ASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ASAD
Middle Name:
Last Name:REDJAI
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 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE 6120
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-784-5300
Mailing Address - Fax:773-784-5391
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 6120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-784-5300
Practice Address - Fax:773-784-5391
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053488207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053488Medicaid
IL650020Medicare ID - Type Unspecified
ILD93821Medicare UPIN