Provider Demographics
NPI:1255373197
Name:KAZMAR, RAYMOND EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:EUGENE
Last Name:KAZMAR
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 1:2555 W. LINCOLN HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1936
Mailing Address - Country:US
Mailing Address - Phone:708-481-4900
Mailing Address - Fax:708-481-9440
Practice Address - Street 1:2555 W. LINCOLN HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:708-481-4900
Practice Address - Fax:708-481-9440
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063879207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622409OtherBCBS ID
IL036063879Medicaid
IL0364268025OtherTAX ID
IL036063879OtherILL. LICENSE
IL660002682OtherRAILROAD MEDICARE
IL036063879OtherILL. LICENSE
IL036063879Medicaid