Provider Demographics
NPI:1942292032
Name:CHERUKURI, RAVI (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:CHERUKURI
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 1:2591 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:STE 302
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3706
Mailing Address - Country:US
Mailing Address - Phone:937-433-7622
Mailing Address - Fax:937-433-7622
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1066
Practice Address - Country:US
Practice Address - Phone:513-420-5755
Practice Address - Fax:513-705-4759
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350841902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2420133Medicaid
OH2420133Medicaid