Provider Demographics
NPI:1215198163
Name:MYDUR, RAVI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:MYDUR
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 1:2500 METROHEALTH DRIVE
Mailing Address - Street 2:METROHEALTH MEDICAL CENTER
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1998
Mailing Address - Country:US
Mailing Address - Phone:216-778-4016
Mailing Address - Fax:216-778-4375
Practice Address - Street 1:2500 METROHEALTH DRIVE
Practice Address - Street 2:METROHEALTH MEDICAL CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1998
Practice Address - Country:US
Practice Address - Phone:216-778-4016
Practice Address - Fax:216-778-4375
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP2-00320862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology