Individual
DR. DAVENDRA P. RAMKUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3101 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 366-6212
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-6212
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036-112654
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036905912 2
—
IL
01
—
279500
MEDICARE GROUP
—
01
—
P00178098
RAILROAD MEDICARE
—
Enumeration date
08/03/2006
Last updated
01/05/2022
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