Provider Demographics
NPI:1679778716
Name:RAMANA, RAVI KUMAR (DO)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:KUMAR
Last Name:RAMANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:HEART CARE CENTERS OF ILLINOIS, S.C.
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:13011 S 104TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1508
Practice Address - Country:US
Practice Address - Phone:708-274-3278
Practice Address - Fax:708-274-3299
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111861207R00000X
IL036111861207RC0000X, 207RI0011X, 207RI0011X
IL042007998207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621208OtherBLUECROSS BLUE SHIELD GROUP NUMBER
ILP00737023OtherRAILROAD MEDICARE PART B GROUP PTAN
IL11969474OtherCAQH
IL236551OtherMEDICARE HCCI GROUP PROVIDER
ILCD8033OtherRAILROAD MEDICARE PART B GROUP PTAN
1508810086OtherHEART CARE CENTERS OF ILLINOIS GROUP NPI
IL416810OtherMEDICARE HCCI GROUP PROVIDER
IL236550OtherMEDICARE HCCI GROUP PROVIDER
IL036111861Medicaid
IL036111861Medicaid
IL416810OtherMEDICARE HCCI GROUP PROVIDER
IL236550002Medicare PIN