Provider Demographics
NPI:1114125028
Name:RAMCHANDANI, MANJU (MD)
Entity Type:Individual
Prefix:
First Name:MANJU
Middle Name:
Last Name:RAMCHANDANI
Suffix:
Gender:F
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:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-343-4440
Mailing Address - Fax:314-343-4439
Practice Address - Street 1:12445 DORSETT RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3907
Practice Address - Country:US
Practice Address - Phone:314-343-4440
Practice Address - Fax:314-343-4439
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233367207Q00000X
IL036-123522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine