Provider Demographics
NPI:1831207430
Name:TAMRAGOURI, RAVIKIRAN N (MD)
Entity type:Individual
Prefix:DR
First Name:RAVIKIRAN
Middle Name:N
Last Name:TAMRAGOURI
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 1:1909 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2602
Mailing Address - Country:US
Mailing Address - Phone:630-241-1616
Mailing Address - Fax:630-541-0066
Practice Address - Street 1:1909 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2602
Practice Address - Country:US
Practice Address - Phone:630-241-1616
Practice Address - Fax:630-541-0066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36073705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE49140Medicare UPIN
IL925290Medicare ID - Type Unspecified