Provider Demographics
NPI:1639196330
Name:RAMADURAI, JAYANTHI R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTHI
Middle Name:R
Last Name:RAMADURAI
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 1:62647 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0626
Mailing Address - Country:US
Mailing Address - Phone:708-424-9710
Mailing Address - Fax:
Practice Address - Street 1:4901 W 79TH ST
Practice Address - Street 2:STE. 5
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1554
Practice Address - Country:US
Practice Address - Phone:708-636-8741
Practice Address - Fax:708-636-8741
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073809207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073809Medicaid
216-22939OtherBLUE SHIELD
900004038OtherPALMETTO GBA
IL036073809Medicaid
552480Medicare PIN
ILIL7138002Medicare PIN