Healthcare Provider Details

I. General information

NPI: 1164508149
Provider Name (Legal Business Name): RAMESH BABU VEMURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S VIRGINIA ST
CRYSTAL LAKE IL
60014-7226
US

IV. Provider business mailing address

145 S VIRGINIA ST
CRYSTAL LAKE IL
60014-7226
US

V. Phone/Fax

Practice location:
  • Phone: 815-444-9999
  • Fax: 815-397-2712
Mailing address:
  • Phone: 815-444-9999
  • Fax: 815-397-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036054365
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number036.054365
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number036.054365
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number036.054365
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: