Provider Demographics
NPI:1952300907
Name:RANGINENI, SUMATHI M (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUMATHI
Middle Name:M
Last Name:RANGINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18210 LA GRANGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7722
Mailing Address - Country:US
Mailing Address - Phone:708-479-6636
Mailing Address - Fax:708-479-9460
Practice Address - Street 1:18210 LA GRANGE RD
Practice Address - Street 2:STE 200
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-7722
Practice Address - Country:US
Practice Address - Phone:708-479-6636
Practice Address - Fax:708-479-9460
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-082859207R00000X
IL036082859208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22913Medicare UPIN
L86663Medicare ID - Type Unspecified