Provider Demographics
NPI:1689686958
Name:JAYANTHI RAMADURAI MD SC
Entity Type:Organization
Organization Name:JAYANTHI RAMADURAI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYANTHI
Authorized Official - Middle Name:R
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 1:4901 W 79TH ST
Practice Address - Street 2:SUITE 2-3
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1554
Practice Address - Country:US
Practice Address - Phone:708-636-1177
Practice Address - Fax:708-636-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360738093Medicaid
216-22939OtherBC BS
216-22939OtherBC BS
IL0360738093Medicaid