Provider Demographics
NPI:1235154519
Name:SHETTY, RAMANANDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMANANDA
Middle Name:M
Last Name:SHETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 SALT CREEK LANE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2962
Mailing Address - Country:US
Mailing Address - Phone:630-734-9560
Mailing Address - Fax:630-734-9565
Practice Address - Street 1:0N126 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1020
Practice Address - Country:US
Practice Address - Phone:630-690-3400
Practice Address - Fax:630-690-3418
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360508282085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050828Medicaid
ILC39358Medicare UPIN
ILK28965Medicare PIN
ILK28990Medicare PIN
ILK28964Medicare PIN