Healthcare Provider Details

I. General information

NPI: 1659371532
Provider Name (Legal Business Name): MEERA RAVIKUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 S WESTERN AVE
CHICAGO IL
60608-3837
US

IV. Provider business mailing address

2355 S WESTERN AVE
CHICAGO IL
60608-3837
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax:
Mailing address:
  • Phone: 773-254-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.103651
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number212859
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: