Individual
RAMAPRASAD KONANUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1300 FRANKLIN AVE, SUITE 250, NORMAL, IL 61761-3592
(309) 268-3589
(309) 268-2536
Mailing address
1300 FRANKLIN AVE, SUITE 250, NORMAL, IL 61761-3592
(309) 268-3589
(309) 268-2536
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
036-111825
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36111825
—
IL
01
—
5715390
BCBS
IL
01
—
809840018
MEDICARE INDIVIDUAL PTAN
IL
01
—
95016
HEALTHALLIANCE
IL
01
—
P00183517
MEDICARE RAILROAD
IL
Enumeration date
07/08/2006
Last updated
08/04/2009
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