Provider Demographics
NPI:1114992237
Name:VEDANTAM, RAVISHANKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVISHANKAR
Middle Name:
Last Name:VEDANTAM
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:PO BOX 1643
Mailing Address - Street 2:CENTRAL INDIANA ORTHOPEDICS, PC
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-1643
Mailing Address - Country:US
Mailing Address - Phone:765-284-7738
Mailing Address - Fax:765-284-4266
Practice Address - Street 1:1050 REID PARKWAY, SUITE 100
Practice Address - Street 2:CENTRAL INDIANA ORTHOPEDICS, PC
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1156
Practice Address - Country:US
Practice Address - Phone:765-983-3373
Practice Address - Fax:765-983-3413
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046839A207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2060719Medicaid
IN200138760Medicaid
G59191Medicare UPIN
OH2060719Medicaid