Provider Demographics
NPI:1538101886
Name:CHANDRASEKARAN, RAVI (DO)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:CHANDRASEKARAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WAUKEGAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2724
Mailing Address - Country:US
Mailing Address - Phone:847-242-6600
Mailing Address - Fax:847-242-6605
Practice Address - Street 1:2 CHABOT ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4817
Practice Address - Country:US
Practice Address - Phone:207-857-9311
Practice Address - Fax:207-857-3924
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1814207R00000X
IL036153018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECHME0161Medicare ID - Type Unspecified
MEH96196Medicare UPIN