Provider Demographics
NPI:1255449484
Name:GOWDA, RAMAYYA U (MD)
Entity type:Individual
Prefix:
First Name:RAMAYYA
Middle Name:U
Last Name:GOWDA
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 1:180 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2608
Mailing Address - Country:US
Mailing Address - Phone:309-647-0201
Mailing Address - Fax:309-649-5101
Practice Address - Street 1:180 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2608
Practice Address - Country:US
Practice Address - Phone:309-647-0201
Practice Address - Fax:309-649-6880
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053154208600000X
IL036-053154208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1942315197OtherNPI CLINIC NUMBER
IL770002357OtherRR MEDICARE PIN
IL02922981OtherBCBS
IL136064OtherHEALTH LINK
IL014148OtherHEALTH ALLIANCE
IL053154OtherOSF HEALTHPLANS
IL0062839OtherUMWA
IL200397OtherBLACK LUNG
IL036053154Medicaid
ILCG5172OtherRR MEDICARE GROUP#
ILIL0108OtherJOHN DEERE
IL02922981OtherBCBS
IL770002357OtherRR MEDICARE PIN
IL0062839OtherUMWA