Provider Demographics
NPI:1689789026
Name:NAYAK, RAVI P (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:P
Last Name:NAYAK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1402 S GRAND BLVD
Mailing Address - Street 2:MC / SLUH / 7FDT
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1004
Mailing Address - Country:US
Mailing Address - Phone:314-577-8856
Mailing Address - Fax:314-577-8859
Practice Address - Street 1:3660 VISTA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2540
Practice Address - Country:US
Practice Address - Phone:314-977-6190
Practice Address - Fax:314-977-5123
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-05-09
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Provider Licenses
StateLicense IDTaxonomies
MO2000173750207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease