Basic Information
| Provider Information | |||||||||
| NPI: | 1659371532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAVIKUMAR | ||||||||
| FirstName: | MEERA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12050 S HARLEM AVE STE A | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604632803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086711500 | ||||||||
| FaxNumber: | 7086711535 | ||||||||
| Practice Location | |||||||||
| Address1: | 12050 S HARLEM AVE STE A | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604632803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086711500 | ||||||||
| FaxNumber: | 7086711535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036.103651 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 212859 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 043202198 | 01 | GREAT WEST HEALTH PLAN | OTHER | 043202198 | 01 | MULTI PLAN | OTHER | 043202198007 | 01 | TRICARE | OTHER | 043202198 | 01 | BEECH STREET | OTHER | 043202198 | 01 | HEALTH CARE VALUE MANAGME | OTHER | 692812 | 01 | HARVARD PILGRIM | OTHER | 0198293 | 05 | MA | MEDICAID | 043202198 | 01 | CONSOLIDATED HEALTH PLAN | OTHER | 043202198 | 01 | FIRST HEALTH | OTHER | 30417 | 01 | HEALTH NEW ENGLAND | OTHER | J24638 | 01 | HMO BLUE | OTHER | 5760653001 | 01 | CIGNA | OTHER | J24638 | 01 | BCBS OF MA | OTHER | 975687 | 01 | NETWORK HEALTH | OTHER | 000000022100 | 01 | BOSTON MEDICAL CENTER HNP | OTHER | 043202198 | 01 | HMC PPO | OTHER | 110242533 | 01 | MA | MEDICARE RAILROAD | OTHER | 212859 | 01 | CONNECTICARE OF MA | OTHER |