Healthcare Provider Details

I. General information

NPI: 1376523647
Provider Name (Legal Business Name): RAMESH SOUNDARARAJAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 15TH ST SUITE 201
CHICAGO HEIGHTS IL
60411-3459
US

IV. Provider business mailing address

210 S DESPLAINES ST
CHICAGO IL
60661-5500
US

V. Phone/Fax

Practice location:
  • Phone: 312-654-2736
  • Fax: 708-221-6454
Mailing address:
  • Phone: 312-654-2700
  • Fax: 312-654-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036076037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: