Raed Abdallah Rtail, SA-C, RSA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

238000322 Issued in IL

Practice address

114 W Rockland Rd
Libertyville, IL 60048-2774

Phone

(847) 353-8802

Fax

(847) 353-8812

NPI assigned

Feb 24, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330041600000",
    "number": "1124392964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 N TALMAN AVE",
            "address_2": "FL. 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252721",
            "telephone_number": "773-961-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 W ROCKLAND RD",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482774",
            "telephone_number": "847-353-8802",
            "fax_number": "847-353-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RTAIL",
        "first_name": "RAED",
        "middle_name": "ABDALLAH",
        "name_prefix": "Mr.",
        "credential": "SA-C, RSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-24",
        "last_updated": "2012-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "238000322",
            "primary": true
        },
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "IL",
            "license": "238000322",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Assistant in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Surgical Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.