Provider Demographics
NPI:1063778462
Name:PRATIVADI, RAMANUJAM GOVINDARAJAN (MD)
Entity type:Individual
Prefix:
First Name:RAMANUJAM
Middle Name:GOVINDARAJAN
Last Name:PRATIVADI
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:1275 E BELVIDERE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2083
Mailing Address - Country:US
Mailing Address - Phone:847-535-7480
Mailing Address - Fax:
Practice Address - Street 1:1000 N WESTMORELAND RD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-535-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361508312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology