Provider Demographics
NPI:1346280203
Name:VEGUNTA, RAVINDRA KUMAR (MBBS, FRCSED)
Entity Type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:KUMAR
Last Name:VEGUNTA
Suffix:
Gender:M
Credentials:MBBS, FRCSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 S DOBSON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4768
Mailing Address - Country:US
Mailing Address - Phone:480-412-9400
Mailing Address - Fax:480-412-9401
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-412-9400
Practice Address - Fax:480-412-9401
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361031872086S0120X
AZ427462086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103187Medicaid
IL809840OtherGROUP
ILK33862OtherINDIVIDUAL
ILG97857Medicare UPIN
ILL97841Medicare ID - Type Unspecified
IL809840OtherGROUP