Active NPI
Jason Michael Razdik, M.D.
- Internal Medicine Physician
- Evanston, IL
National Provider Identifier
1689823940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 125-054580
- Practice address
- 2650 Ridge Ave
Evanston, IL 60201-1718 - Phone
- (847) 570-2409
- NPI assigned
- Sep 11, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 125-054580 | IL | Primary |
Addresses
Primary practice location
2650 Ridge Ave
Evanston, IL 60201-1718
Mailing address
2117 Lake Ave Apt 4
Wilmette, IL 60091-1400
Phone (847) 728-0492
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125-054580 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221091200000",
"number": "1689823940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2117 LAKE AVE APT 4",
"city": "WILMETTE",
"state": "IL",
"postal_code": "600911400",
"telephone_number": "847-728-0492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011718",
"telephone_number": "847-570-2409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAZDIK",
"first_name": "JASON",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-11",
"last_updated": "2008-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125-054580",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.