Provider Demographics
NPI:1730306358
Name:RAMASAMY, SHANMUGAVELAYUTHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANMUGAVELAYUTHAM
Middle Name:
Last Name:RAMASAMY
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 1:7933 OAKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3742
Mailing Address - Country:US
Mailing Address - Phone:630-730-2159
Mailing Address - Fax:630-910-4674
Practice Address - Street 1:7933 OAKVIEW LN
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3742
Practice Address - Country:US
Practice Address - Phone:630-730-2159
Practice Address - Fax:630-910-4674
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052036173000000X
IL036-052031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG12703Medicare UPIN