Basic Information
| Provider Information | |||||||||
| NPI: | 1295700979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUCHIPUDI | ||||||||
| FirstName: | RAMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1880 W WINCHESTER RD | ||||||||
| Address2: | 101 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472819543 | ||||||||
| FaxNumber: | 8472819615 | ||||||||
| Practice Location | |||||||||
| Address1: | 1880 W WINCHESTER RD | ||||||||
| Address2: | 101 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472819543 | ||||||||
| FaxNumber: | 8472819615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 111282 | 01 | IL | HEALTH PARTNERS | OTHER | 0004930110 | 01 | IL | BCBS | OTHER | P00045772 | 01 | IL | RAILROAD MEDICARE | OTHER |