Ramayya U Gowda, M.D.
Individual provider Active NPI Surgery Physician · Canton, IL
NPI 1255449484 · NPPES record last updated Apr 15, 2016
Key facts
- NPI
- 1255449484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 036-053154 (IL)
- Practice address
- 180 South Main Street
Canton, IL 61520-2608 - Phone
- (309) 647-0201
- Fax
- (309) 649-6880
- NPI assigned
- Aug 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-053154 | IL | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Graham Services Corporation | Surgery | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036053154 | IL | |
| Surgery Physician | 208600000X | 036-053154 | IL | Yes |
Addresses
Primary practice location
180 South Main Street
Canton, IL 61520-2608
Mailing address
180 South Main Street
Canton, IL 61520-2608
Phone (309) 647-0201
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942315197 | Other | IL | NPI CLINIC NUMBER |
| 770002357 | Other | IL | RR MEDICARE PIN |
| 02922981 | Other | IL | BCBS |
| 136064 | Other | IL | HEALTH LINK |
| 014148 | Other | IL | HEALTH ALLIANCE |
| 053154 | Other | IL | OSF HEALTHPLANS |
| 0062839 | Other | IL | UMWA |
| 200397 | Other | IL | BLACK LUNG |
| 036053154 | Medicaid | IL | |
| CG5172 | Other | IL | RR MEDICARE GROUP# |
| IL0108 | Other | IL | JOHN DEERE |
Other providers in Canton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.