Provider Demographics
NPI:1932355013
Name:RAGAM, AVANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:AVANTHI
Middle Name:
Last Name:RAGAM
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 1:351 DELNOR DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4220
Mailing Address - Country:US
Mailing Address - Phone:630-232-0610
Mailing Address - Fax:630-232-0675
Practice Address - Street 1:351 DELNOR DR
Practice Address - Street 2:SUITE 410
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4220
Practice Address - Country:US
Practice Address - Phone:630-232-0610
Practice Address - Fax:630-232-0675
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112502207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
ILP01093156OtherMEDICARE RAILROAD PTAN (INDIVIDUAL)
IL206147088OtherMEDICARE PTAN (INDIVIDUAL)
ILCA4748OtherMEDICARE RAILROAD PTAN (GROUP)
IL036112502Medicaid