Provider Demographics
NPI:1548214711
Name:RAMAKRISHNA, RENUKA J (MD)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:J
Last Name:RAMAKRISHNA
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 1:400 N WALL ST STE 308
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2964
Mailing Address - Country:US
Mailing Address - Phone:815-936-7122
Mailing Address - Fax:815-936-7339
Practice Address - Street 1:400 N WALL ST STE 308
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2964
Practice Address - Country:US
Practice Address - Phone:815-936-7122
Practice Address - Fax:815-936-7339
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063413207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063413Medicaid
IL036063413Medicaid