Healthcare Provider Details

I. General information

NPI: 1134802077
Provider Name (Legal Business Name): RAUNAQ S RATRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COMMERCIAL DR
MAHOMET IL
61853-8625
US

IV. Provider business mailing address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3981
US

V. Phone/Fax

Practice location:
  • Phone: 217-586-6600
  • Fax: 217-366-5358
Mailing address:
  • Phone: 217-366-1200
  • Fax: 217-366-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125083023
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: