Provider Demographics
NPI:1235352766
Name:DANDAMUDI, RAMA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMA
Middle Name:R
Last Name:DANDAMUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 S YORK RD
Mailing Address - Street 2:SUITE 4250
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5626
Mailing Address - Country:US
Mailing Address - Phone:630-758-5759
Mailing Address - Fax:630-758-8751
Practice Address - Street 1:1200 S YORK RD
Practice Address - Street 2:SUITE 4250
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:630-758-5759
Practice Address - Fax:630-758-8751
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206871Medicare ID - Type Unspecified
ILG56178Medicare UPIN