Provider Demographics
NPI:1184679334
Name:PALAKODETI, RATNA K (MD)
Entity Type:Individual
Prefix:
First Name:RATNA
Middle Name:K
Last Name:PALAKODETI
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 1:1911 N FAIRFIELD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2762
Mailing Address - Country:US
Mailing Address - Phone:937-429-1369
Mailing Address - Fax:937-429-4575
Practice Address - Street 1:1911 N FAIRFIELD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2762
Practice Address - Country:US
Practice Address - Phone:937-429-1369
Practice Address - Fax:937-429-4575
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-1212P207Q00000X
OH35.061212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0847409Medicaid
OH0847409Medicaid
E75619Medicare UPIN