Provider Demographics
NPI:1275577512
Name:KOLA, RAMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:
Last Name:KOLA
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 1:15 W PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1050
Mailing Address - Country:US
Mailing Address - Phone:815-786-9197
Mailing Address - Fax:815-786-9199
Practice Address - Street 1:15 W PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1050
Practice Address - Country:US
Practice Address - Phone:815-786-9197
Practice Address - Fax:815-786-9199
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074269207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001932075OtherBLUE CROSS BLUE SHIELD
14D1047350OtherCLIA
K 25281Medicare ID - Type Unspecified
IL0001932075OtherBLUE CROSS BLUE SHIELD
IL5771880001Medicare NSC