Provider Demographics
NPI:1922288703
Name:PRAMOD RAVAL M.D P.C.
Entity Type:Organization
Organization Name:PRAMOD RAVAL M.D P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TUSHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPATHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-369-3379
Mailing Address - Street 1:3120 CARPENTER ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-9802
Mailing Address - Country:US
Mailing Address - Phone:313-369-3379
Mailing Address - Fax:313-893-6346
Practice Address - Street 1:3120 CARPENTER ST
Practice Address - Street 2:SUITE 313
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-9802
Practice Address - Country:US
Practice Address - Phone:313-369-3379
Practice Address - Fax:313-893-6346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty