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Individual

MRS. LATHA RAVI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
180 SOUTH THIRD STREET, SUITE 102, BELLEVILLE, IL 62220
(618) 235-2511
(618) 235-2548
Mailing address
180 SOUTH THIRD STREET, SUITE 102, BELLEVILLE, IL 62220
(618) 235-2511
(618) 235-2548

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-072768
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0008200539
BCBS OF IL
IL
01
250002252
RAILROAD MEDICARE PIN
IL
01
33725
GROUP HEALTH PLAN
Enumeration date
07/29/2006
Last updated
05/22/2008
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