Provider Demographics
NPI:1639363377
Name:RAVI BADLANI MDSC
Entity Type:Organization
Organization Name:RAVI BADLANI MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BADLANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-883-3953
Mailing Address - Street 1:2266 N LINCOLN AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7600
Mailing Address - Country:US
Mailing Address - Phone:773-883-3953
Mailing Address - Fax:
Practice Address - Street 1:2266 N LINCOLN AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-883-3953
Practice Address - Fax:773-883-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095133 1Medicaid
ILG56655Medicare UPIN
IL209319Medicare PIN