Healthcare Provider Details

I. General information

NPI: 1811126733
Provider Name (Legal Business Name): RAVINIA HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15030 S RAVINIA AVE STE 38
ORLAND PARK IL
60462-3258
US

IV. Provider business mailing address

15030 S RAVINIA AVE STE 38
ORLAND PARK IL
60462-3258
US

V. Phone/Fax

Practice location:
  • Phone: 847-215-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LANA MOSHKOVICH
Title or Position: CMM, CPC, CEMC
Credential:
Phone: 847-904-7500