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General NPI Number Information
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NPI Number | 1083760573
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Entity Type | Organization
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Legal Business Name | RAVI MEDICAL GROUP SC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 2340 S HIGHLAND AVE SUITE 260
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City | LOMBARD
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State | IL
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Zip | 60148-5371
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Country | US
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Telephone | 630-889-2000
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Fax | 630-889-2299
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Provider Business Mailing Address
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Address Line | 2340 S HIGHLAND AVE SUITE 260
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City | LOMBARD
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State | IL
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Zip | 60148-5371
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Country | US
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Telephone | 630-889-2000
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Fax | 630-889-2299
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Authorized Official
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Title or Position | TREASURER
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Name | MRS. MALINI RAVI
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Credential |
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Telephone | 630-889-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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