Provider Demographics
NPI:1245543628
Name:RAUL G SAAVEDRA MD LTD
Entity type:Organization
Organization Name:RAUL G SAAVEDRA MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-660-0500
Mailing Address - Street 1:1101 LAKE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1085
Mailing Address - Country:US
Mailing Address - Phone:708-660-0500
Mailing Address - Fax:708-763-0827
Practice Address - Street 1:1101 LAKE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1085
Practice Address - Country:US
Practice Address - Phone:708-660-0500
Practice Address - Fax:708-763-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043160207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1467484063OtherBLUE CROSS BLUE SHIELD
IL036043160Medicaid
KY1467484063OtherBLUE CROSS BLUE SHIELD