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General NPI Number Information
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NPI Number | 1104231364
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Entity Type | Organization
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Legal Business Name | RAMV RUDRA INC
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 908 N ELM ST STE 109
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City | HINSDALE
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State | IL
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Zip | 60521-2602
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Country | US
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Telephone | 630-965-2225
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Fax | 708-452-1444
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Provider Business Mailing Address
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Address Line | 571 N 6TH AVE
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City | ADDISON
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State | IL
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Zip | 60101-1318
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Country | US
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Telephone | 630-965-2225
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Fax | 708-452-1444
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANISH PANDYA
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Credential | DC
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Telephone | 630-965-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | IL
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