Provider Demographics
NPI:1134257660
Name:RAFA S ADI MD LTD
Entity type:Organization
Organization Name:RAFA S ADI MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-362-5344
Mailing Address - Street 1:1870 W WINCHESTER RD
Mailing Address - Street 2:SUITE 246
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5358
Mailing Address - Country:US
Mailing Address - Phone:847-362-5344
Mailing Address - Fax:847-362-5332
Practice Address - Street 1:1870 W WINCHESTER RD
Practice Address - Street 2:SUITE 246
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5358
Practice Address - Country:US
Practice Address - Phone:847-362-5344
Practice Address - Fax:847-362-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04921389OtherBLUE CROSS BLUE SHIELD
ILG57983Medicare UPIN
ILK35275Medicare ID - Type Unspecified