Provider Demographics
NPI:1528172954
Name:MULTACK, RICHARD FLOYD (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:FLOYD
Last Name:MULTACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20303 S CRAWFORD AVENUE
Mailing Address - Street 2:SUITE LL 1
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1030
Mailing Address - Country:US
Mailing Address - Phone:708-898-1858
Mailing Address - Fax:708-898-1860
Practice Address - Street 1:20303 CRAWFORD AVE
Practice Address - Street 2:SUITE LL 1
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1073
Practice Address - Country:US
Practice Address - Phone:708-898-1858
Practice Address - Fax:708-898-1860
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059149207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059149Medicaid
180014262OtherR/R MEDICARE
IL669022Medicare ID - Type Unspecified
IL036059149Medicaid
IL200377Medicare ID - Type Unspecified