Provider Demographics
NPI:1568029361
Name:RAMESH, GAUTAM (MD)
Entity type:Individual
Prefix:DR
First Name:GAUTAM
Middle Name:
Last Name:RAMESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:180 HARVESTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6686
Mailing Address - Country:US
Mailing Address - Phone:773-702-1150
Mailing Address - Fax:
Practice Address - Street 1:4701 TOWNE CENTRE RD STE 201
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2833
Practice Address - Country:US
Practice Address - Phone:989-792-2792
Practice Address - Fax:989-792-1792
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361640482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology