Gangadhariah, Ravindrakumar
Gangadhariah, Ravindrakumar is an individual health care provider with primary practice located at 4624 Progress Drive Ste D , Davenport IA 52807. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Gangadhariah, Ravindrakumar can be contacted via phone (563) 355-0015.Contact Information
Primary practice address
4624 Progress Drive Ste D
Davenport IA 52807
Phone: (563) 355-0015
Fax: (563) 355-0013
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 036-115671 | Illinois |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 036115671 | Illinois |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 36638 | Iowa |
Profile Details
| NPI number | 1922047869 |
|---|---|
| LBN Legal business name | Gangadhariah, Ravindrakumar |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2006 |
| Last updated | Apr 4th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922047869 | NPPES |
| Illinois | MEDICAID | 036115671 | |
| Illinois | MEDICAID | 0744987 |
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