Provider Demographics
NPI:1811236573
Name:UMESH RATURI, MD PA
Entity Type:Organization
Organization Name:UMESH RATURI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:813-632-8000
Mailing Address - Street 1:PO BOX 47389
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0112
Mailing Address - Country:US
Mailing Address - Phone:813-632-8000
Mailing Address - Fax:813-632-8001
Practice Address - Street 1:13701 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4647
Practice Address - Country:US
Practice Address - Phone:813-632-8000
Practice Address - Fax:813-632-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066647500Medicaid
FLHR751AMedicare PIN
FLD63681Medicare UPIN
FL066647500Medicaid