Healthcare Provider Details

I. General information

NPI: 1063581064
Provider Name (Legal Business Name): VIMALA RAMAKRISHNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N. COUNTY FARM RD DUPAGE COUNTY HEALTH DEPARTMENT
WHEATON IL
60187-3977
US

IV. Provider business mailing address

1658 CARDINAL DR
MUNSTER IN
46321-3905
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7979
  • Fax: 630-682-9572
Mailing address:
  • Phone: 219-924-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01026049A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: