Provider Demographics
NPI:1275568800
Name:RAVVIN, LEON J (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:J
Last Name:RAVVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE A-540
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-258-6760
Mailing Address - Fax:859-258-6512
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE A-540
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-258-6760
Practice Address - Fax:859-258-6512
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY20154207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64201544Medicaid
KYASC1019OtherASC MEDICARE GROUP
KYCB5773OtherRR MEDICARE GROUP
KY37903705OtherMEDICAID LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
KY36000818OtherASC MEDICAID GROUP
KY64201544Medicaid
KY37903705OtherMEDICAID LAB GROUP