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Organization

INTERNAL MEDICINE CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RAVIKIRAN N TAMRAGOURI MD (PRESIDENT)
(630) 241-1616
Entity
Organization

Contact information

Practice address
1909 OGDEN AVE, DOWNERS GROVE, IL 60515-2602
(630) 241-1616
(630) 541-0066
Mailing address
1909 OGDEN AVE, DOWNERS GROVE, IL 60515-2602
(630) 241-1616
(630) 541-0066

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
036073705
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036073705
IL
01
2215606
BLUE CROSS
IL
Enumeration date
01/18/2008
Last updated
05/10/2010
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