Provider Demographics
NPI:1457396608
Name:KOTI, RAVI K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:K
Last Name:KOTI
Suffix:
Gender:M
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 1988
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-1988
Mailing Address - Country:US
Mailing Address - Phone:352-671-4422
Mailing Address - Fax:352-671-4423
Practice Address - Street 1:2494 SW 19TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7859
Practice Address - Country:US
Practice Address - Phone:352-671-4422
Practice Address - Fax:352-671-4423
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93537207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16668OtherBC/BS FLORIDA
FL273187800Medicaid
H93285Medicare UPIN
FLU54062Medicare PIN