Provider Demographics
NPI:1093788879
Name:RAVIPATI, NAGESH B (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGESH
Middle Name:B
Last Name:RAVIPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:13770 PLANTATION RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4301
Practice Address - Country:US
Practice Address - Phone:239-275-0728
Practice Address - Fax:239-275-6947
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ36251208600000X
MN104528208C00000X
FLME102588208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00956367OtherRAILROAD MEDICARE
FL149XHOtherBCBS FL
FL341426OtherAVMED HMO/EPN THRU LEE PHO
FL002755200Medicaid
FL7783774OtherCIGNA
FLP930873OtherOPTIMUM
FLP985345OtherFREEDOM HEALTH
FL1235326OtherWELLCARE
FL9014393OtherAETNA
FLP985345OtherFREEDOM HEALTH