MEDICARE: DR. LETTRICIA RAJIE GUNARATNAM 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	207Q00000X	Family Medicine Physician	336036066245	IL

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

General Provider Information

NPI Number	:	1851449060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETTRICIA RAJIE GUNARATNAM M.D.

Provider Business Mailing Address
First Line	:	542 RIDGE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-2863
Country	:	US
Telephone Number	:	773-528-5400
Fax Number	:	773-528-0607

Provider Business Practice Location Address
First Line	:	2143 W WELLINGTON AVE STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8288
Country	:	US
Telephone Number	:	773-528-5400
Fax Number	:	773-528-0607

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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