Provider Demographics
NPI:1508899634
Name:RAVINIA ASSOCIATES IN INTERNAL MEDICINE, LTD
Entity Type:Organization
Organization Name:RAVINIA ASSOCIATES IN INTERNAL MEDICINE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REFERRALS
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-681-4224
Mailing Address - Street 1:1777 GREEN BAY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3297
Mailing Address - Country:US
Mailing Address - Phone:847-433-3460
Mailing Address - Fax:847-433-4062
Practice Address - Street 1:1777 GREEN BAY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3297
Practice Address - Country:US
Practice Address - Phone:847-433-3460
Practice Address - Fax:847-433-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL693810Medicare ID - Type Unspecified
IL6075270001Medicare NSC