Provider Demographics
NPI:1952677718
Name:EVALDAS RADZEVICIUS P.C.
Entity Type:Organization
Organization Name:EVALDAS RADZEVICIUS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVALDAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RADZEVICIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-915-8600
Mailing Address - Street 1:19550 GOVERNORS HWY
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2125
Mailing Address - Country:US
Mailing Address - Phone:708-915-8600
Mailing Address - Fax:708-915-8612
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 3700
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-915-8600
Practice Address - Fax:708-915-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361260352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036126035OtherSTATE LICENSE