MEDICARE: ANSHU RAVULA

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	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1275106759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANSHU RAVULA

Provider Business Mailing Address
First Line	:	75 EXECUTIVE DR STE 403
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8112
Country	:	US
Telephone Number	:	630-448-8000
Fax Number	:	630-448-8001

Provider Business Practice Location Address
First Line	:	75 EXECUTIVE DR STE 403
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8112
Country	:	US
Telephone Number	:	630-448-8000
Fax Number	:	630-448-8001

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	07/21/2021

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Directions to “ ANSHU RAVULA ” Practice Location

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