Provider Demographics
NPI:1306028303
Name:RAVULA, RAJNIKANTH (MD)
Entity Type:Individual
Prefix:
First Name:RAJNIKANTH
Middle Name:
Last Name:RAVULA
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 1:3800 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4499
Mailing Address - Country:US
Mailing Address - Phone:602-900-9466
Mailing Address - Fax:800-230-9466
Practice Address - Street 1:3800 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4499
Practice Address - Country:US
Practice Address - Phone:602-900-9466
Practice Address - Fax:800-230-9466
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ352910Medicaid
AZ352910Medicaid