Provider Demographics
NPI:1003143835
Name:REVAN MARAGIRI MD PLC
Entity Type:Organization
Organization Name:REVAN MARAGIRI MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:REVANASIDDAPPA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARAGIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-415-0358
Mailing Address - Street 1:3720 KATALIN CT
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2160
Mailing Address - Country:US
Mailing Address - Phone:989-415-0358
Mailing Address - Fax:
Practice Address - Street 1:3720 KATALIN CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2160
Practice Address - Country:US
Practice Address - Phone:989-415-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty