Provider Demographics
NPI:1326321449
Name:THIMMISETTY, RAVI K (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:K
Last Name:THIMMISETTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-998-7400
Mailing Address - Fax:505-998-7740
Practice Address - Street 1:3821 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4679
Practice Address - Country:US
Practice Address - Phone:505-998-7400
Practice Address - Fax:505-998-7740
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2021-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE6626207R00000X
MO2016038126207RN0300X
NMMD2021-0293207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine