Provider Demographics
NPI:1275622128
Name:RAVISHANKAR, KEMPSAGAR C (MD)
Entity Type:Individual
Prefix:DR
First Name:KEMPSAGAR
Middle Name:C
Last Name:RAVISHANKAR
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 1:7215 OLD OAK BLVD STE A411
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3334
Mailing Address - Country:US
Mailing Address - Phone:440-826-9221
Mailing Address - Fax:440-816-5399
Practice Address - Street 1:7215 OLD OAK BLVD STE A411
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3334
Practice Address - Country:US
Practice Address - Phone:440-826-9221
Practice Address - Fax:440-816-5399
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068631204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0946169Medicaid
OH1579165OtherCIGNA
OHP00036566OtherMEDICARE RAILROAD
OH0500150OtherUNITED HEALTH CARE INS
OH108691OtherKAISER INS
OH7543555OtherAETNA INS
OH53284OtherQUAL CHOICE INS
OH203918OtherANTHEM
OHF29053Medicare UPIN
OH9344111Medicare PIN