Provider Demographics
NPI:1750376869
Name:RADZEVICIUS, EVALDAS (MD)
Entity type:Individual
Prefix:DR
First Name:EVALDAS
Middle Name:
Last Name:RADZEVICIUS
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 1:14315 108TH AVE
Mailing Address - Street 2:STE 215
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5701
Mailing Address - Country:US
Mailing Address - Phone:708-966-0993
Mailing Address - Fax:708-966-0997
Practice Address - Street 1:14315 108TH AVE
Practice Address - Street 2:STE 215
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5701
Practice Address - Country:US
Practice Address - Phone:708-966-0993
Practice Address - Fax:708-966-0997
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2020-05-12
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
AL24217103TF0000X
IL0361260352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009984865Medicaid
ALP00358766OtherMEDICARE ID
IL036126035Medicaid
ALK377OtherMEDICARE GROUP
ALP00358766OtherMEDICARE ID
AL051555014Medicare PIN
AL051526663Medicare PIN