Provider Demographics
NPI:1922395151
Name:PALMAS & RAM RUDRA LLC
Entity type:Organization
Organization Name:PALMAS & RAM RUDRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT1
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1773-823-1333
Mailing Address - Street 1:3836 S ARCHER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1014
Mailing Address - Country:US
Mailing Address - Phone:773-823-1333
Mailing Address - Fax:773-823-1313
Practice Address - Street 1:1247 S. CESAR E. CHAVES DRIVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204
Practice Address - Country:US
Practice Address - Phone:773-823-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty