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NPI Code Detail

MEDICARE: BHAGAVATULA RAMAKRISHNA MD

MEDICARE: BHAGAVATULA RAMAKRISHNA MD
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
1207RI0200XInfectious Disease Physician036-050628IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2F400293103OTHERILMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
321622441OTHERILBCBS PROVIDER ID

General Provider Information

NPI Number : 1629063243
Entity Type Code : Individual
Provider Name (Legal Business Name) : BHAGAVATULA RAMAKRISHNA MD
Provider Business Mailing Address
First Line : 12251 S 80TH AVE
Second Line : SUITE 1630
City : PALOS HEIGHTS
State : IL
Zip : 60463-1256
Country : US
Telephone Number : 708-923-5173
Fax Number : 708-923-5018
Provider Business Practice Location Address
First Line : 12251 S 80TH AVE
Second Line : SUITE 1630
City : PALOS HEIGHTS
State : IL
Zip : 60463-1256
Country : US
Telephone Number : 708-923-7874
Fax Number : 708-923-7873
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 01/24/2017

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Practice Location Address:
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