Avtar K Razdan I, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

036048822 Issued in IL

Practice address

475 Brown Blvd
Suite 102
Bourbonnais, IL 60914-2325

Phone

(815) 939-0003

Fax

(815) 935-4908

NPI assigned

Aug 23, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348790400000",
    "number": "1376536615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 BROWN BLVD",
            "address_2": "SUITE 102",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142325",
            "telephone_number": "815-939-0003",
            "fax_number": "815-935-4908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 BROWN BLVD",
            "address_2": "SUITE 102",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142325",
            "telephone_number": "815-939-0003",
            "fax_number": "815-935-4908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAZDAN",
        "first_name": "AVTAR",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2012-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "IL",
            "license": "036048822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "04607499",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036048822",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Niveditha Rajagopalan, D.M.D.
• Erik Ranta, O.D.
• Issra Rashed, MD
• Dina Rashid, DMD
• Stacie Maryann Raymond, D.C.
• Rebecca Ellen Counseling Inc
• Dena Kay Reddick, FNP-BC
• Laura Redenius
• Steven Reiter, D.P.T
• Renal Treatment Centers-Illinois Inc

• All providers in Bourbonnais, IL
• Pediatric Adolescent Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.