Provider Demographics
NPI:1285622621
Name:BARIDI, REFAT (MD)
Entity type:Individual
Prefix:
First Name:REFAT
Middle Name:
Last Name:BARIDI
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 1:7425 JANES AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2356
Mailing Address - Country:US
Mailing Address - Phone:815-300-7764
Mailing Address - Fax:
Practice Address - Street 1:7425 JANES AVE
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2356
Practice Address - Country:US
Practice Address - Phone:815-300-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087412207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087412Medicaid
IL830007376OtherRAILROAD MEDICARE
ILIL3596017OtherLOCALITY 15 PTAN
IL036087412Medicaid
ILIL3596017OtherLOCALITY 15 PTAN
ILIL3596017Medicare PIN
575720Medicare PIN