Provider Demographics
NPI:1235193558
Name:RAVI, SHIVARAJPUR K (MD)
Entity Type:Individual
Prefix:
First Name:SHIVARAJPUR
Middle Name:K
Last Name:RAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2802 GARTH RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3900
Mailing Address - Country:US
Mailing Address - Phone:281-428-7330
Mailing Address - Fax:281-428-7251
Practice Address - Street 1:2802 GARTH RD
Practice Address - Street 2:SUITE 207
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3900
Practice Address - Country:US
Practice Address - Phone:281-428-7330
Practice Address - Fax:281-428-7251
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ38822084N0400X, 2084P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115563202Medicaid
TXF67919Medicare UPIN
TX115563202Medicaid