Provider Demographics
NPI:1184697476
Name:RAIF, KORHAN B (MD)
Entity type:Individual
Prefix:
First Name:KORHAN
Middle Name:B
Last Name:RAIF
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 1:868 MORTIMER ST
Mailing Address - Street 2:
Mailing Address - City:BARRY
Mailing Address - State:IL
Mailing Address - Zip Code:62312-1249
Mailing Address - Country:US
Mailing Address - Phone:217-335-2343
Mailing Address - Fax:
Practice Address - Street 1:868 MORTIMER ST
Practice Address - Street 2:
Practice Address - City:BARRY
Practice Address - State:IL
Practice Address - Zip Code:62312-1249
Practice Address - Country:US
Practice Address - Phone:217-335-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092531Medicaid
G33838Medicare UPIN
IL468740Medicare PIN
IL110165035Medicare PIN