Provider Demographics
NPI:1972682334
Name:RAVENELL, RONEKA LEANTRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONEKA
Middle Name:LEANTRICE
Last Name:RAVENELL
Suffix:
Gender:F
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3897 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9562
Practice Address - Country:US
Practice Address - Phone:502-495-3665
Practice Address - Fax:502-874-5536
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL27031207R00000X
KYTP872207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000720689OtherANTHEM- NORTON RHEUMATOLOGY SPECIALISTS
KY7100174210Medicaid
KY50036616OtherPASSPORT- NORTON RHEUMATOLOGY SPECIALISTS
KY127892OtherSIHO- NORTON RHEUMATOLOGY SPECIALISTS
IN201048430Medicaid
KY7100174210Medicaid