Provider Demographics
NPI:1316142755
Name:SADIQ, RAJA IRFAN (M,D)
Entity type:Individual
Prefix:DR
First Name:RAJA IRFAN
Middle Name:
Last Name:SADIQ
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4369
Mailing Address - Country:US
Mailing Address - Phone:217-443-9100
Mailing Address - Fax:217-443-6792
Practice Address - Street 1:735 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4369
Practice Address - Country:US
Practice Address - Phone:217-443-9100
Practice Address - Fax:217-443-6792
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121961208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207928002Medicare PIN