Individual
DR. JAYANTHI R RAMADURAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4901 W 79TH ST, STE. 5, BURBANK, IL 60459-1554
(708) 636-8741
(708) 636-8741
Mailing address
62647 COLLECTION CENTER DR, CHICAGO, IL 60693-0626
(708) 424-9710
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036073809
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073809
—
IL
01
—
216-22939
BLUE SHIELD
—
01
—
900004038
PALMETTO GBA
—
Enumeration date
07/17/2006
Last updated
06/05/2015
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