Basic Information
| Provider Information | |||||||||
| NPI: | 1902216492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANDER | ||||||||
| FirstName: | RAVI | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE. | ||||||||
| Address2: | IM HOSPITALISTS STE 4210 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701010 | ||||||||
| FaxNumber: | 8477335108 | ||||||||
| Practice Location | |||||||||
| Address1: | 2845 GREENBRIER RD | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543116519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202888100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 67691-20 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036152011 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 67691 | WI | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 036152011 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 390200000X | 01 | IL | STUDENT HEALTH CARE | OTHER |