MEDICARE: DR. RAGHAVENDRA VEERAPANENI 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	173000000X	Legal Medicine	036054308	IL
2	207Q00000X	Family Medicine Physician	036054308	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	F400195122	OTHER	IL	MEDICARE PTAN
4	080165393	OTHER	IL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0001623866	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1780695023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGHAVENDRA VEERAPANENI M.D.

Provider Business Mailing Address
First Line	:	30 E 15TH ST
Second Line	:	SUITE 202
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3459
Country	:	US
Telephone Number	:	708-754-7777
Fax Number	:	708-754-7811

Provider Business Practice Location Address
First Line	:	30 E 15TH ST
Second Line	:	SUITE 202
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3459
Country	:	US
Telephone Number	:	708-754-7777
Fax Number	:	708-754-7811

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	08/24/2015

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Directions to “ DR. RAGHAVENDRA VEERAPANENI M.D.” Practice Location

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