Provider Demographics
NPI:1598044562
Name:PAVANI, RAM
Entity Type:Individual
Prefix:
First Name:RAM
Middle Name:
Last Name:PAVANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ROSETTA LN
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-9653
Mailing Address - Country:US
Mailing Address - Phone:307-634-2763
Mailing Address - Fax:
Practice Address - Street 1:160 ROSETTA LN
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-9653
Practice Address - Country:US
Practice Address - Phone:307-634-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker