Healthcare Provider Details

I. General information

NPI: 1134502263
Provider Name (Legal Business Name): RAMYASHREE TUMMALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 NE CRESCENT AVE
PEORIA IL
61606-1901
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-4670
  • Fax: 309-672-4669
Mailing address:
  • Phone: 217-383-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036158350
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: