Provider Demographics
NPI:1295538965
Name:SHANKER, RAVI
Entity type:Individual
Prefix:MR
First Name:RAVI
Middle Name:
Last Name:SHANKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 ASCOTT LANE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:MI
Mailing Address - Zip Code:48390
Mailing Address - Country:US
Mailing Address - Phone:248-706-1138
Mailing Address - Fax:
Practice Address - Street 1:4101 ASCOTT LANE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:MI
Practice Address - Zip Code:48390
Practice Address - Country:US
Practice Address - Phone:248-706-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant