Healthcare Provider Details

I. General information

NPI: 1730306358
Provider Name (Legal Business Name): SHANMUGAVELAYUTHAM RAMASAMY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7933 OAKVIEW LN
WOODRIDGE IL
60517-3742
US

IV. Provider business mailing address

7933 OAKVIEW LN
WOODRIDGE IL
60517-3742
US

V. Phone/Fax

Practice location:
  • Phone: 630-730-2159
  • Fax: 630-910-4674
Mailing address:
  • Phone: 630-730-2159
  • Fax: 630-910-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036052036
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-052031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: