Healthcare Provider Details

I. General information

NPI: 1326350083
Provider Name (Legal Business Name): LISA RAVINDRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 N MICHIGAN AVE STE 1300
CHICAGO IL
60611-4513
US

IV. Provider business mailing address

980 N MICHIGAN AVE STE 1300
CHICAGO IL
60611-4513
US

V. Phone/Fax

Practice location:
  • Phone: 872-224-3645
  • Fax: 312-449-8671
Mailing address:
  • Phone: 872-224-3645
  • Fax: 312-449-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.020553
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125058865
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36133449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: