Individual
DR. MAMATA RAVIPATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3471 GREEN BAY RD, NORTH CHICAGO, IL 60064-3090
(847) 473-4357
Mailing address
3537 PAYSPHERE CIR, CHICAGO, IL 60674-0035
(708) 786-2900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-104010
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-104010-2
—
IL
Enumeration date
10/11/2005
Last updated
09/26/2016
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