Provider Demographics
NPI:1477751055
Name:RAMANAVARAPU, VIDYA (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:RAMANAVARAPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34121 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1341
Mailing Address - Country:US
Mailing Address - Phone:224-231-4363
Mailing Address - Fax:866-642-1525
Practice Address - Street 1:1010 EXECUTIVE DR STE 250
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6137
Practice Address - Country:US
Practice Address - Phone:630-920-2350
Practice Address - Fax:630-323-5610
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133269207L00000X
MA231705207L00000X
IL036-133269208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2142465Medicaid
IL036133269Medicaid
MAJ42311OtherBCBSMA
MA000252902Medicare PIN
MAJ42311OtherBCBSMA
MA000252901Medicare PIN