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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922047869 NPPES
Illinois MEDICAID 036115671
Illinois MEDICAID 0744987

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