Provider Demographics
NPI:1245459023
Name:SHELDON J RAVIN DO PC
Entity type:Organization
Organization Name:SHELDON J RAVIN DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-636-3783
Mailing Address - Street 1:155 PRINTERS PKWY
Mailing Address - Street 2:STE 250
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-6100
Mailing Address - Country:US
Mailing Address - Phone:719-636-3783
Mailing Address - Fax:
Practice Address - Street 1:155 PRINTERS PKWY
Practice Address - Street 2:STE 250
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-6100
Practice Address - Country:US
Practice Address - Phone:719-636-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty