Provider Demographics
NPI:1780414268
Name:RADWAN, ABDUL RAHMAN
Entity type:Individual
Prefix:
First Name:ABDUL RAHMAN
Middle Name:
Last Name:RADWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 AMERICANA DR APT 601
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2246
Mailing Address - Country:US
Mailing Address - Phone:312-619-0221
Mailing Address - Fax:
Practice Address - Street 1:44 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4402
Practice Address - Country:US
Practice Address - Phone:312-619-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-23-294321106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician