Provider Demographics
NPI:1063814861
Name:RANGARAJAN, SRIRAM (MD)
Entity Type:Individual
Prefix:
First Name:SRIRAM
Middle Name:
Last Name:RANGARAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 PARK AVE W STE 2850
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2558
Mailing Address - Country:US
Mailing Address - Phone:847-570-1700
Mailing Address - Fax:224-251-5470
Practice Address - Street 1:757 PARK AVE W STE 2850
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2558
Practice Address - Country:US
Practice Address - Phone:847-570-1700
Practice Address - Fax:224-251-5470
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036166978208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery