Provider Demographics
NPI:1295812451
Name:JEFFREY J RAGER DPM,PC
Entity type:Organization
Organization Name:JEFFREY J RAGER DPM,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-275-5250
Mailing Address - Street 1:1487 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3614
Mailing Address - Country:US
Mailing Address - Phone:847-681-9424
Mailing Address - Fax:847-675-7450
Practice Address - Street 1:1487 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3614
Practice Address - Country:US
Practice Address - Phone:847-681-9424
Practice Address - Fax:847-675-7450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634664OtherBLUE CROSS BLUE SHIELD NU
IL210776OtherMEDICARE NUMBER