Basic Information
| Provider Information | |||||||||
| NPI: | 1154347748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VENKATARAMAN | ||||||||
| FirstName: | S | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10458 S PULASKI RD | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604534933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086361818 | ||||||||
| FaxNumber: | 7086362151 | ||||||||
| Practice Location | |||||||||
| Address1: | 10458 S PULASKI RD | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604534933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086361818 | ||||||||
| FaxNumber: | 7086362151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 036067578 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 036067578 | 05 | IL | MEDICAID | 0031601474 | 01 | IL | BLUE SHIELD | OTHER | 110023497 | 01 | IL | RAILROAD MEDICARE | OTHER |