Provider Demographics
NPI:1760812978
Name:DR RAMAN POPLI AND ASSOCIATES
Entity Type:Organization
Organization Name:DR RAMAN POPLI AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAN
Authorized Official - Middle Name:INDER
Authorized Official - Last Name:POPLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-363-6055
Mailing Address - Street 1:5415 BULL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7410
Mailing Address - Country:US
Mailing Address - Phone:815-363-6055
Mailing Address - Fax:815-363-6150
Practice Address - Street 1:145 S VIRGINIA ST STE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7226
Practice Address - Country:US
Practice Address - Phone:815-363-6055
Practice Address - Fax:815-363-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH32985Medicare UPIN