Provider Demographics
NPI:1467563957
Name:GURUJAL, RAVI (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:GURUJAL
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 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:1010 CEREAL AVE STE 207
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2772
Practice Address - Country:US
Practice Address - Phone:513-867-3331
Practice Address - Fax:513-867-2667
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-109978207RC0000X
OH35.120296207RC0000X, 207RI0011X
IN01061340A207RC0000X
KYC0932207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201055350Medicaid
IL36109978Medicaid
IN000000542034OtherBCBS
IN01061340AMedicaid
OH0075371Medicaid
IL36109978Medicaid
OHH151642Medicare PIN
INM400068796Medicare PIN