Provider Demographics
NPI:1235237082
Name:RAMANATHAN, PERIAKARUPPAN (MD)
Entity Type:Individual
Prefix:
First Name:PERIAKARUPPAN
Middle Name:
Last Name:RAMANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P
Other - Middle Name:R
Other - Last Name:RAMANATHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2535 BETHANY ROAD
Mailing Address - Street 2:#110
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178
Mailing Address - Country:US
Mailing Address - Phone:815-756-1434
Mailing Address - Fax:815-756-4776
Practice Address - Street 1:2535 BETHANY ROAD
Practice Address - Street 2:#110
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178
Practice Address - Country:US
Practice Address - Phone:815-756-1434
Practice Address - Fax:815-756-4776
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01900093OtherBLUE CROSS
D09770Medicare UPIN
IL211340Medicare ID - Type Unspecified