Provider Demographics
NPI:1396728390
Name:RAMACHANDRAN, ASHA R (MD)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:R
Last Name:RAMACHANDRAN
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 1:3241 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4201
Mailing Address - Country:US
Mailing Address - Phone:312-949-7770
Mailing Address - Fax:312-949-7742
Practice Address - Street 1:3241 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4201
Practice Address - Country:US
Practice Address - Phone:312-949-7770
Practice Address - Fax:312-949-7742
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1302208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177989401Medicaid
TX177989402Medicaid
TX177989402Medicaid
TX8G2247Medicare PIN