Provider Demographics
NPI:1346272549
Name:RAM, ANIL K (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:K
Last Name:RAM
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 1:6410 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7622
Mailing Address - Country:US
Mailing Address - Phone:352-563-2450
Mailing Address - Fax:352-563-2512
Practice Address - Street 1:6410 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7622
Practice Address - Country:US
Practice Address - Phone:352-563-2450
Practice Address - Fax:352-563-2512
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD191900207RG0100X
FLME0062021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370673700Medicaid
FLE65570Medicare UPIN