Provider Demographics
NPI:1841269727
Name:RANGANATHAN, THODUR M (MD)
Entity type:Individual
Prefix:
First Name:THODUR
Middle Name:M
Last Name:RANGANATHAN
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 1:13290 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8194
Mailing Address - Country:US
Mailing Address - Phone:630-257-0885
Mailing Address - Fax:630-257-0875
Practice Address - Street 1:7531 S STONY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3954
Practice Address - Country:US
Practice Address - Phone:773-947-7900
Practice Address - Fax:773-947-7901
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0814412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-081441Medicaid
E54902Medicare UPIN
IL036-081441Medicaid
ILK10774Medicare PIN