Provider Demographics
NPI:1700477262
Name:RADO, JAMES ELLIOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ELLIOTT
Last Name:RADO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ELLIOTT
Other - Middle Name:
Other - Last Name:RADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6356 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2202
Mailing Address - Country:US
Mailing Address - Phone:708-907-4355
Mailing Address - Fax:
Practice Address - Street 1:6356 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2202
Practice Address - Country:US
Practice Address - Phone:708-907-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant