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455 E Main St East Dundee IL 60118-1529 | |
| (847) 428-2273 | |
| (847) 428-3128 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 455 E Main St, East Dundee, Illinois |
| Authorized Official Name and Position | Srinivas R Ravanam (PRESIDENT) |
| Authorized Official Contact | 8474282273 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
455 E Main St East Dundee IL 60118-1529 Ph: (847) 428-2273 | 455 E Main St East Dundee IL 60118-1529 Ph: (847) 428-2273 |
| NPI Number | 1104075365 |
|---|---|
| Provider Enumeration Date | 09/12/2008 |
| Last Update Date | 07/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104075365 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036110141 (Illinois) | Primary |
| 207R00000X | Internal Medicine | 036110401 (Illinois) | Secondary |
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