Provider Demographics
NPI:1992701015
Name:RAGONA, BRIAN P (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:RAGONA
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1050 ESSINGTON RD STE C
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8416
Practice Address - Country:US
Practice Address - Phone:815-729-0129
Practice Address - Fax:815-729-1643
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069543207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110097513OtherRAILROAD MEDICARE
IL036069543Medicaid
IL09919564OtherBLUECROSSBLUESHIELD OF IL
IL09919564OtherBLUECROSSBLUESHIELD OF IL
IL036069543Medicaid