Provider Demographics
NPI:1356677835
Name:SHUKLA, RAVIKUMAR K (RPT)
Entity Type:Individual
Prefix:MR
First Name:RAVIKUMAR
Middle Name:K
Last Name:SHUKLA
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Gender:M
Credentials:RPT
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Mailing Address - Street 1:5511 W US HIGHWAY 10
Mailing Address - Street 2:SUITE # B
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2455
Mailing Address - Country:US
Mailing Address - Phone:231-845-0900
Mailing Address - Fax:231-845-0909
Practice Address - Street 1:751 KENMOOR AVE SE
Practice Address - Street 2:SUITE # E
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2388
Practice Address - Country:US
Practice Address - Phone:616-954-7013
Practice Address - Fax:616-954-7014
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2011-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501013597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501013597OtherSTATE OF MICHIGAN