MEDICARE: DR. MEERA RAVIKUMAR MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036.103651	IL
2	207R00000X	Internal Medicine Physician	212859	MA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	110242533	OTHER	MA	MEDICARE RAILROAD

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	043202198	OTHER	CONSOLIDATED HEALTH PLAN
2	043202198	OTHER	FIRST HEALTH
3	043202198007	OTHER	TRICARE
4	043202198	OTHER	HEALTH CARE VALUE MANAGME
6	212859	OTHER	CONNECTICARE OF MA
7	692812	OTHER	HARVARD PILGRIM
8	043202198	OTHER	GREAT WEST HEALTH PLAN
9	J24638	OTHER	HMO BLUE
10	043202198	OTHER	HMC PPO
11	043202198	OTHER	BEECH STREET
12	043202198	OTHER	MULTI PLAN
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	30417	OTHER	HEALTH NEW ENGLAND
15	000000022100	OTHER	BOSTON MEDICAL CENTER HNP
16	5760653001	OTHER	CIGNA
17	975687	OTHER	NETWORK HEALTH
18	J24638	OTHER	BCBS OF MA

NPI Number	:	1659371532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEERA RAVIKUMAR MD

Provider Business Mailing Address
First Line	:	2355 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3837
Country	:	US
Telephone Number	:	773-254-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3837
Country	:	US
Telephone Number	:	773-254-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/04/2025

2355 S. WESTERN AVE.
CHICAGO, IL
60608-3837

Practice Phone: 773-254-1400
Practice Fax: 312-829-6673