Provider Demographics
NPI:1750368445
Name:RAVULA, RADHIKA E (MD)
Entity type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:E
Last Name:RAVULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 ALLIANCE BLVD
Mailing Address - Street 2:STE 850
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5343
Mailing Address - Country:US
Mailing Address - Phone:469-814-5960
Mailing Address - Fax:
Practice Address - Street 1:4708 ALLIANCE BLVD STE 850
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5343
Practice Address - Country:US
Practice Address - Phone:469-814-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8450207L00000X, 2084P2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101180103Medicaid
TX101180104Medicaid
TX101180105Medicaid
TX8G2125OtherBLUE CROSS BLUE SHIELD
TX720000337OtherRAILROAD
TX8G2125OtherBLUE CROSS BLUE SHIELD
TX8A3309Medicare PIN
TX8A3325Medicare PIN
TX101180105Medicaid
TX101180104Medicaid