Provider Demographics
NPI:1164493441
Name:RAVI, BARUGUR S (MD)
Entity Type:Individual
Prefix:
First Name:BARUGUR
Middle Name:S
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 1:1031 HIGHLANDS PLAZA DR W
Mailing Address - Street 2:APT # 111
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1303
Mailing Address - Country:US
Mailing Address - Phone:205-266-1321
Mailing Address - Fax:
Practice Address - Street 1:3635 VISTA AT GRAND BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-577-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2947-R207P00000X
CAC53465207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000305682OtherBLUECROSS BLUESHIELD
OH2439025Medicaid
OH000000305682OtherBLUECROSS BLUESHIELD
OH2439025Medicaid