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Individual

DR. RAGHAVENDRA VEERAPANENI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
30 E 15TH ST, SUITE 202, CHICAGO HEIGHTS, IL 60411-3459
(708) 754-7777
(708) 754-7811
Mailing address
30 E 15TH ST, SUITE 202, CHICAGO HEIGHTS, IL 60411-3459
(708) 754-7777
(708) 754-7811

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
036054308
IL
207Q00000X
Family Medicine Physician
036054308
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0001623866
BLUE CROSS BLUE SHIELD
IL
05
036054308
IL
01
080165393
MEDICARE RAILROAD
IL
01
F400195122
MEDICARE PTAN
IL
Enumeration date
08/11/2006
Last updated
08/24/2015
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