Provider Demographics
NPI:1780780114
Name:MEDAVARAM, RAMA (MD)
Entity type:Individual
Prefix:DR
First Name:RAMA
Middle Name:
Last Name:MEDAVARAM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 W LARAWAY RD STE 1E
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-6401
Mailing Address - Country:US
Mailing Address - Phone:630-202-4261
Mailing Address - Fax:224-246-8127
Practice Address - Street 1:10850 W LARAWAY RD STE 1E
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-6401
Practice Address - Country:US
Practice Address - Phone:630-202-4261
Practice Address - Fax:224-246-8127
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7663829OtherCIGNA
IL31602204OtherBLUE CROSS BLUE SHIELD
IL036065913Medicaid
ILD93957Medicare UPIN
IL036065913Medicaid