Provider Demographics
NPI:1164577565
Name:TRIVEDI, RAVI K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:K
Last Name:TRIVEDI
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 1:1585 BARRINGTON RD
Mailing Address - Street 2:DOCTORS BUILDING II, SUITE 605
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1090
Mailing Address - Country:US
Mailing Address - Phone:847-755-1111
Mailing Address - Fax:847-755-1166
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:DOCTORS BUILDING II, SUITE 605
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1090
Practice Address - Country:US
Practice Address - Phone:847-755-1111
Practice Address - Fax:847-755-1166
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14932Medicare UPIN