MEDICARE: DR. RAMESH BABU VEMURI 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	2084P0800X	Psychiatry Physician	036054365	IL
2	251S00000X	Community/Behavioral Health Agency
3	2084P0802X	Addiction Psychiatry Physician	036.054365	IL
4	2084P0805X	Geriatric Psychiatry Physician	036.054365	IL
5	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	036.054365	IL
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036054365	OTHER	IL	PHYSICIAN LICENSE

General Provider Information

NPI Number	:	1164508149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMESH BABU VEMURI M.D.

Provider Business Mailing Address
First Line	:	145 S VIRGINIA ST
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7226
Country	:	US
Telephone Number	:	815-444-9999
Fax Number	:	815-397-2712

Provider Business Practice Location Address
First Line	:	145 S VIRGINIA ST
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7226
Country	:	US
Telephone Number	:	815-444-9999
Fax Number	:	815-397-2712

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	02/28/2017

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