Healthcare Provider Details

I. General information

NPI: 1699189878
Provider Name (Legal Business Name): RAVI VALLURIPALLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 04/30/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE DEPT OF PSYCHIATRY
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE. DEPT OF PSYCHIATRY
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-425-6400
  • Fax:
Mailing address:
  • Phone: 847-425-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125-064235
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: