Healthcare Provider Details

I. General information

NPI: 1275460388
Provider Name (Legal Business Name): ISHITA RAY M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637
US

IV. Provider business mailing address

530 NE GLEN OAK AVE OSF ST. FRANCIS MEDICAL CENTER INTERNAL MEDICINE RESIDENCY ATTN: MARTI SOKOLOWSKI
PEORIA IL
61637
US

V. Phone/Fax

Practice location:
  • Phone: 308-962-4935
  • Fax: 309-655-7732
Mailing address:
  • Phone: 308-962-4935
  • Fax: 309-655-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: