Provider Demographics
NPI:1932163045
Name:RAMANI, KISHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHIN
Middle Name:
Last Name:RAMANI
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 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:3231 EUCLID AVE STE 201
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3472
Practice Address - Country:US
Practice Address - Phone:708-783-2055
Practice Address - Fax:708-783-2181
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087942207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621208OtherBLUECROSS BLUE SHIELD
IL036087942Medicaid
IL060053216OtherRAILROAD MEDICARE WILL
IL060057755OtherRAILROAD MEDICARE KANKAKE
IL236550OtherMEDICARE GROUP
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL060042296OtherRAILROAD MEDICARE COOK
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL1508810086OtherGROUP NPI
IL236551OtherMEDICARE GROUP
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILL57369Medicare ID - Type Unspecified
IL01621208OtherBLUECROSS BLUE SHIELD
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER