Healthcare Provider Details

I. General information

NPI: 1336211630
Provider Name (Legal Business Name): SAI S RAMASASTRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

820 S WOOD ST 515 CSN, MC 958
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 312-996-9313
  • Fax: 312-413-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036087786
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: