Provider Demographics
NPI:1225005440
Name:PANKAJ, RAM S (MD)
Entity Type:Individual
Prefix:MR
First Name:RAM
Middle Name:S
Last Name:PANKAJ
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 1:600 E FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362
Mailing Address - Country:US
Mailing Address - Phone:815-664-5343
Mailing Address - Fax:
Practice Address - Street 1:600 E FIRST STREET
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362
Practice Address - Country:US
Practice Address - Phone:815-664-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK09540Medicare ID - Type Unspecified
C45175Medicare UPIN
ILK02479Medicare ID - Type Unspecified