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NPI Code Detail

MEDICARE: DR. RAVISHANKAR HASANADKA M.D.

MEDICARE: DR. RAVISHANKAR HASANADKA 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
12086S0129XVascular Surgery Physician36123015IL
22086S0129XVascular Surgery PhysicianMD154236OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699858068
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAVISHANKAR HASANADKA M.D.
Provider Business Mailing Address
First Line : PO BOX 372
Second Line :
City : MATTOON
State : IL
Zip : 61938-0372
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 HEALTH CENTER DR
Second Line :
City : MATTOON
State : IL
Zip : 61938-4644
Country : US
Telephone Number : 217-258-4049
Fax Number : 217-238-4491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2006
Last Update Date : 03/25/2026

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