Provider Demographics
NPI:1184605032
Name:RAVIKANT, SARALA S (MD)
Entity type:Individual
Prefix:DR
First Name:SARALA
Middle Name:S
Last Name:RAVIKANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:38815 DEQUINDRE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-879-8080
Mailing Address - Fax:248-879-3462
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:SUITE 512
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-879-8080
Practice Address - Fax:248-879-3462
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301033574207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1095232Medicaid
MI1095232Medicaid
B42974Medicare UPIN