Basic Information
| Provider Information | |||||||||
| NPI: | 1619081072 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAGHU RAMADURAI, M.D SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 798 | ||||||||
| Address2: | |||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600680798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476926218 | ||||||||
| FaxNumber: | 8476925609 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 W DIVISION ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606222717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733423333 | ||||||||
| FaxNumber: | 7733423334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | RAMADURAI | ||||||||
| AuthorizedOfficialFirstName: | RAGHU | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8476926218 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0360692861 | 05 | IL | MEDICAID |