Provider Demographics
NPI:1184691826
Name:VAELA, RAVI (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:VAELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAVI
Other - Middle Name:
Other - Last Name:RAMAKRISHNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:490 S MAPLE ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1760
Mailing Address - Country:US
Mailing Address - Phone:952-442-2191
Mailing Address - Fax:952-442-8081
Practice Address - Street 1:490 S MAPLE ST
Practice Address - Street 2:SUITE 216
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1760
Practice Address - Country:US
Practice Address - Phone:952-442-2191
Practice Address - Fax:952-442-8081
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051926207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN492478100Medicaid
INH08700Medicare UPIN