Provider Demographics
NPI:1932102084
Name:ADUSUMILLI, RAVI K (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:K
Last Name:ADUSUMILLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3000
Mailing Address - Fax:419-842-3048
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-842-3048
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081344207RC0000X
OH35069014207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00751116OtherRAILROAD MEDICARE
OH0178623Medicaid
OH060060579Medicare PIN
P00751116OtherRAILROAD MEDICARE
E21287Medicare UPIN
OH0178623Medicaid
OH4042624Medicare PIN
OH4042628Medicare PIN
OHAD4257781Medicare PIN
OH0792003Medicare PIN
OH4042627Medicare PIN
MIMI1635021Medicare PIN
MIMI1635026Medicare PIN
OH0792002Medicare PIN