Provider Demographics
NPI:1235176710
Name:MIDIDODDI, RAVI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:MIDIDODDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NATARAJU
Other - Middle Name:RAVINDER
Other - Last Name:MIDIDODDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:408 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3014
Mailing Address - Country:US
Mailing Address - Phone:512-451-5800
Mailing Address - Fax:512-459-1399
Practice Address - Street 1:16010 PARK VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3575
Practice Address - Country:US
Practice Address - Phone:512-320-1500
Practice Address - Fax:512-459-1399
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4881207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182797409Medicaid
TX182797409Medicaid