Provider Demographics
NPI:1699858068
Name:HASANADKA, RAVISHANKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVISHANKAR
Middle Name:
Last Name:HASANADKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 W PARK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2368
Mailing Address - Country:US
Mailing Address - Phone:217-337-3240
Mailing Address - Fax:217-337-3241
Practice Address - Street 1:1405 W PARK ST STE 201
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2368
Practice Address - Country:US
Practice Address - Phone:217-337-3240
Practice Address - Fax:217-337-3241
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361230152086S0129X
ORMD1542362086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123015Medicaid
OR500636610Medicaid
OR500636610Medicaid
ILF400125802Medicare PIN
IL036123015Medicaid