Individual
BHAGAVATULA RAMAKRISHNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12251 S 80TH AVE, SUITE 1630, PALOS HEIGHTS, IL 60463-1256
(708) 923-7874
(708) 923-7873
Mailing address
12251 S 80TH AVE, SUITE 1630, PALOS HEIGHTS, IL 60463-1256
(708) 923-5173
(708) 923-5018
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
036-050628
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036050628
—
IL
01
—
21622441
BCBS PROVIDER ID
IL
01
—
F400293103
MEDICARE PTAN
IL
Enumeration date
09/20/2005
Last updated
01/24/2017
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