Healthcare Provider Details

I. General information

NPI: 1104231364
Provider Name (Legal Business Name): RAMV RUDRA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N ELM ST STE 109
HINSDALE IL
60521-2602
US

IV. Provider business mailing address

571 N 6TH AVE
ADDISON IL
60101-1318
US

V. Phone/Fax

Practice location:
  • Phone: 630-965-2225
  • Fax: 708-452-1444
Mailing address:
  • Phone: 630-965-2225
  • Fax: 708-452-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MANISH PANDYA
Title or Position: PRESIDENT
Credential: DC
Phone: 630-965-2225