Healthcare Provider Details

I. General information

NPI: 1114190949
Provider Name (Legal Business Name): RAYAL GORREPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N RANDOLPH ST 2ND FLOOR OFFICE 246
CHAMPAIGN IL
61820
US

IV. Provider business mailing address

206 N RANDOLPH ST 2ND FLOOR OFFICE 246
CHAMPAIGN IL
61820
US

V. Phone/Fax

Practice location:
  • Phone: 833-251-8255
  • Fax: 888-815-3583
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.125453
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14761
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036125453
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: