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General NPI Number Information
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NPI Number | 1588840607
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE CENTER
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 1909 OGDEN AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2602
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Country | US
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Telephone | 630-241-1616
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Fax | 630-541-0066
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Provider Business Mailing Address
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Address Line | 1909 OGDEN AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2602
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Country | US
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Telephone | 630-241-1616
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Fax | 630-541-0066
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAVIKIRAN N TAMRAGOURI
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Credential | MD
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Telephone | 630-241-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036073705
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License Number State | IL
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