Provider Demographics
NPI:1659371532
Name:RAVIKUMAR, MEERA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEERA
Middle Name:
Last Name:RAVIKUMAR
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 1:12050 S HARLEM AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2803
Mailing Address - Country:US
Mailing Address - Phone:708-671-1500
Mailing Address - Fax:708-671-1535
Practice Address - Street 1:12050 S HARLEM AVE STE A
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2803
Practice Address - Country:US
Practice Address - Phone:708-671-1500
Practice Address - Fax:708-671-1535
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.103651207R00000X
MA212859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
043202198OtherGREAT WEST HEALTH PLAN
043202198OtherMULTI PLAN
043202198007OtherTRICARE
043202198OtherBEECH STREET
043202198OtherHEALTH CARE VALUE MANAGME
692812OtherHARVARD PILGRIM
MA0198293Medicaid
043202198OtherCONSOLIDATED HEALTH PLAN
043202198OtherFIRST HEALTH
30417OtherHEALTH NEW ENGLAND
J24638OtherHMO BLUE
5760653001OtherCIGNA
J24638OtherBCBS OF MA
975687OtherNETWORK HEALTH
000000022100OtherBOSTON MEDICAL CENTER HNP
043202198OtherHMC PPO
MA110242533OtherMEDICARE RAILROAD
212859OtherCONNECTICARE OF MA
000000022100OtherBOSTON MEDICAL CENTER HNP
212859OtherCONNECTICARE OF MA