Provider Demographics
NPI:1841357845
Name:SRINIVAS, RATNA R (MD)
Entity type:Individual
Prefix:DR
First Name:RATNA
Middle Name:R
Last Name:SRINIVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3151
Mailing Address - Country:US
Mailing Address - Phone:815-344-4499
Mailing Address - Fax:815-344-4779
Practice Address - Street 1:3922 MERCY DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3151
Practice Address - Country:US
Practice Address - Phone:815-344-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-067679207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WISRINIRATOtherMERCYCARE INSURANCE
IL036067679 2Medicaid
WISRINIRATOtherMERCYCARE INSURANCE
IL214660K08515Medicare PIN