MEDICARE: DR RAMAN POPLI AND ASSOCIATES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036104035	IL

General Provider Information

NPI Number	:	1760812978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR RAMAN POPLI AND ASSOCIATES

Provider Business Mailing Address
First Line	:	5415 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-363-6055
Fax Number	:	815-363-6150

Provider Business Practice Location Address
First Line	:	145 S VIRGINIA ST STE C
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7226
Country	:	US
Telephone Number	:	815-363-6055
Fax Number	:	815-363-6150

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAMAN INDER POPLI
Credential	:	M.D.
Telephone Number	:	815-363-6055

Provider Enumeration Date	:	11/25/2013
Last Update Date	:	09/09/2021

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