Provider Demographics
NPI:1225839459
Name:LAMAR, RA'KEISHA T
Entity type:Individual
Prefix:
First Name:RA'KEISHA
Middle Name:T
Last Name:LAMAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-1230
Mailing Address - Country:US
Mailing Address - Phone:773-749-6120
Mailing Address - Fax:
Practice Address - Street 1:418 N RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-1230
Practice Address - Country:US
Practice Address - Phone:773-749-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL56073884770172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver