Basic Information
| Provider Information | |||||||||
| NPI: | 1710943220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAFF | ||||||||
| FirstName: | LESTER | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2225 ENTERPRISE DR | ||||||||
| Address2: | SUITE 2511 | ||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601545814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084860076 | ||||||||
| FaxNumber: | 7084860080 | ||||||||
| Practice Location | |||||||||
| Address1: | 2225 ENTERPRISE DR | ||||||||
| Address2: | SUITE 2511 | ||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601545814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084860076 | ||||||||
| FaxNumber: | 7084860080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 036060672 | IL | N | Other Service Providers | Specialist | 207ZP0105X | 036-060672 | IL | N | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 207ZP0102X | 036-060672 | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | P00299126 | 01 | RAILROAD MEDICARE | OTHER | 036060672 | 05 | IL | MEDICAID |