Individual
RAVI MISHRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.B.B.S.
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 296-5435
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
036-112466
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-112466
—
IL
01
—
214881
MEDICARE GROUP ID
IL
Enumeration date
06/04/2006
Last updated
08/09/2022
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