MEDICARE: SUNANDA RAVELLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician		IL

General Provider Information

NPI Number	:	1164471033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNANDA RAVELLA M.D.

Provider Business Mailing Address
First Line	:	4753 N ELSTON AVE
Second Line	:	MAYFAIR HEALTHCARE CENTER
City	:	CHICAGO
State	:	IL
Zip	:	60630-4002
Country	:	US
Telephone Number	:	773-205-7200
Fax Number	:	773-481-7577

Provider Business Practice Location Address
First Line	:	4753 N ELSTON AVE
Second Line	:	MAYFAIR HEALTHCARE CENTER
City	:	CHICAGO
State	:	IL
Zip	:	60630-4002
Country	:	US
Telephone Number	:	773-205-7200
Fax Number	:	773-481-7577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/21/2022

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