MEDICARE: DR. NIRMALA M RAY M.D.

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	207K00000X	Allergy & Immunology Physician	036074141	IL

General Provider Information

NPI Number	:	1770671893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIRMALA M RAY M.D.

Provider Business Mailing Address
First Line	:	6320 159TH ST
Second Line	:	SUITE A
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2776
Country	:	US
Telephone Number	:	708-687-3855
Fax Number	:	708-444-2324

Provider Business Practice Location Address
First Line	:	6320 159TH ST
Second Line	:	SUITE A
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2776
Country	:	US
Telephone Number	:	708-687-3855
Fax Number	:	708-444-2324

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	12/02/2014

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