MEDICARE: RAVISHANKAR SERVICE CORPORATION

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	207L00000X	Anesthesiology Physician	036077082	IL

General Provider Information

NPI Number	:	1215188024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVISHANKAR SERVICE CORPORATION

Provider Business Mailing Address
First Line	:	912 SAINT STEPHENS GRN
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-2568
Country	:	US
Telephone Number	:	630-926-3096
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 SAINT STEPHENS GRN
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-2568
Country	:	US
Telephone Number	:	630-926-3096
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NARAYANARAO RAVISHANKAR
Credential	:	M.D
Telephone Number	:	630-926-3096

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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Directions to “RAVISHANKAR SERVICE CORPORATION ” Practice Location

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