Provider Demographics
NPI:1679856710
Name:MIRPURI, RAVI (DO)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:MIRPURI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110820
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0114
Mailing Address - Country:US
Mailing Address - Phone:239-591-2803
Mailing Address - Fax:239-594-5637
Practice Address - Street 1:4513 EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119
Practice Address - Country:US
Practice Address - Phone:239-591-2803
Practice Address - Fax:239-591-2803
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS117942081P2900X, 208VP0014X
FLUO2718208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice