Provider Demographics
NPI:1790969657
Name:MAHIPAL RAVIPATI
Entity Type:Organization
Organization Name:MAHIPAL RAVIPATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MAHIPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-350-1965
Mailing Address - Street 1:2426 DANVILLE RD SW STE P
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4294
Mailing Address - Country:US
Mailing Address - Phone:256-350-1965
Mailing Address - Fax:256-351-5146
Practice Address - Street 1:2426 DANVILLE RD SW STE P
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4294
Practice Address - Country:US
Practice Address - Phone:256-350-1965
Practice Address - Fax:256-351-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ927Medicare PIN