Healthcare Provider Details

I. General information

NPI: 1770671893
Provider Name (Legal Business Name): NIRMALA M RAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 159TH ST SUITE A
OAK FOREST IL
60452-2776
US

IV. Provider business mailing address

6320 159TH ST SUITE A
OAK FOREST IL
60452-2776
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-3855
  • Fax: 708-444-2324
Mailing address:
  • Phone: 708-687-3855
  • Fax: 708-444-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036074141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: