Provider Demographics
NPI:1487643920
Name:RAVI, KUMAR L (MD)
Entity Type:Individual
Prefix:
First Name:KUMAR
Middle Name:L
Last Name:RAVI
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 1:10503 W THUNDERBIRD BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3022
Mailing Address - Country:US
Mailing Address - Phone:623-974-3649
Mailing Address - Fax:623-974-8464
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:STE 103
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-974-3649
Practice Address - Fax:623-974-8464
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32398207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ847171Medicaid
AZZ123657Medicare PIN
AZ847171Medicaid
AZZ123658Medicare PIN
AZZ103714Medicare PIN
AZZ123656Medicare PIN