Provider Demographics
NPI:1033101076
Name:RAVI, KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:
Last Name:RAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:BAYONET POINT
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6716
Mailing Address - Country:US
Mailing Address - Phone:727-861-9800
Mailing Address - Fax:727-862-1235
Practice Address - Street 1:7575 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:BAYONET POINT
Practice Address - State:FL
Practice Address - Zip Code:34667-6716
Practice Address - Country:US
Practice Address - Phone:727-861-9800
Practice Address - Fax:727-862-1235
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D58775Medicare UPIN
FL79410VMedicare ID - Type Unspecified