Provider Demographics
NPI:1578040101
Name:RAMU, SIVAKUMAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIVAKUMAR
Middle Name:
Last Name:RAMU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6558 TEALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3276
Mailing Address - Country:US
Mailing Address - Phone:312-259-6180
Mailing Address - Fax:
Practice Address - Street 1:603 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-1329
Practice Address - Country:US
Practice Address - Phone:630-521-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D2142429247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician