Provider Demographics
NPI:1700980414
Name:KILEY, RAYMOND JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JAMES
Last Name:KILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:715 LAKE ST
Mailing Address - Street 2:SUITE 812
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1422
Mailing Address - Country:US
Mailing Address - Phone:708-386-9146
Mailing Address - Fax:708-445-1868
Practice Address - Street 1:715 LAKE ST
Practice Address - Street 2:SUITE 812
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1422
Practice Address - Country:US
Practice Address - Phone:708-386-9146
Practice Address - Fax:708-445-1868
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics