Provider Demographics
NPI:1578502399
Name:RAVITSKY, MICHAEL A (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:RAVITSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1094 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7021
Mailing Address - Country:US
Mailing Address - Phone:561-255-3131
Mailing Address - Fax:855-215-9930
Practice Address - Street 1:4700 N CONGRESS AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-255-3131
Practice Address - Fax:855-346-3451
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003855207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060013128OtherRR MEDICARE
FL037709100Medicaid
FL064516800OtherGRP
FL050003855OtherMED LICENSE
FLAR8119528OtherDEA
FL82197Medicare ID - Type Unspecified
FLAR8119528OtherDEA
FL050003855OtherMED LICENSE