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Individual
SRINIVAS R RAVANAM
Active
Individual
SRINIVAS R RAVANAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036110141
IL
207U00000X
Nuclear Medicine Physician
036110141
IL
2083X0100X
Occupational Medicine Physician
036110141
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110141
—
IL
01
—
46940020
STATE LICENSE
WI
Enumeration date
05/22/2006
Last updated
02/24/2014
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