Basic Information
| Provider Information | |||||||||
| NPI: | 1801805437 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARIGALA | ||||||||
| FirstName: | RAVIKIRAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 W MEDICAL CENTER DR | ||||||||
| Address2: | HOSPITALIST PROGRAM | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7797712843 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4201 W MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157594323 | ||||||||
| FaxNumber: | 8157598154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 06/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36115178 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036115178 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 036115178 | 01 | IL | STATE LICENSE | OTHER | 336076205 | 01 | IL | CONTROLLED SUBSTANCE LISC | OTHER | 36115178 | 01 | IL | PHYSICIAN LISCENSE | OTHER | 51049020 | 01 | WI | PHYSICIAN LICENCE | OTHER | FB0611194 | 01 | DEA | OTHER |