Provider Demographics
NPI:1619081072
Name:RAGHU RAMADURAI, M.D SC
Entity Type:Organization
Organization Name:RAGHU RAMADURAI, M.D SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMADURAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-692-6218
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-0798
Mailing Address - Country:US
Mailing Address - Phone:847-692-6218
Mailing Address - Fax:847-692-5609
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-342-3333
Practice Address - Fax:773-342-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360692861Medicaid
IL0360692861Medicaid
IL209662Medicare PIN