Provider Demographics
NPI:1558369132
Name:RAVAL, ASHWIN N (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWIN
Middle Name:N
Last Name:RAVAL
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 1:12611 PENNSYLVANIA RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4224
Mailing Address - Country:US
Mailing Address - Phone:734-285-5280
Mailing Address - Fax:734-285-6730
Practice Address - Street 1:12611 PENNSYLVANIA RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48192-4224
Practice Address - Country:US
Practice Address - Phone:734-285-5280
Practice Address - Fax:734-285-6730
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAR035652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI091591OtherAETNA
MI10055271OtherRAILROAD MEDICARE
MI700H249950OtherBCBC BCN
MI024660OtherMIDWEST
MI1558369132Medicaid
MI080265372OtherBCBS
MI1585565Medicaid
MI080265372OtherBCN
MI0M93170Medicare PIN
MIF05616Medicare UPIN