Provider Demographics
NPI:1548452188
Name:MADHAV T RATNAKAR, MD P C
Entity type:Organization
Organization Name:MADHAV T RATNAKAR, MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHAV
Authorized Official - Middle Name:T
Authorized Official - Last Name:RATNAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-734-7820
Mailing Address - Street 1:103 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-1751
Mailing Address - Country:US
Mailing Address - Phone:309-734-7820
Mailing Address - Fax:309-734-5299
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1751
Practice Address - Country:US
Practice Address - Phone:309-734-7820
Practice Address - Fax:309-734-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10200028Medicaid
IL1639124472OtherNPI
IL1639124472OtherNPI
ILK05205Medicare PIN