Provider Demographics
NPI:1124017827
Name:TAK, RAVINDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:S
Last Name:TAK
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 1:1134 KELTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3100
Mailing Address - Country:US
Mailing Address - Phone:407-306-6306
Mailing Address - Fax:407-306-6304
Practice Address - Street 1:1134 KELTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3100
Practice Address - Country:US
Practice Address - Phone:407-306-6306
Practice Address - Fax:407-306-6304
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002339700Medicaid
23378XMedicare PIN
FL002339700Medicaid