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General NPI Number Information
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NPI Number | 1427611565
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Entity Type | Individual
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Provider Name | VINAYA RAMESH SOUNDARARAJAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1415 W 47TH ST
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City | LA GRANGE
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State | IL
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Zip | 60525-6136
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Country | US
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Telephone | 219-878-5020
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Fax | 219-861-8146
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Provider Business Mailing Address
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Address Line | 1311 S RIDGE RD
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City | WILLOWBROOK
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State | IL
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Zip | 60527-1921
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Country | US
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Telephone | 630-362-4283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036172297
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License Number State | IL
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