Provider Demographics
NPI:1750539268
Name:RAVURI, SURESH KUMAR (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:KUMAR
Last Name:RAVURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SURESH
Other - Middle Name:K
Other - Last Name:RAVURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-686-6605
Mailing Address - Fax:432-682-2284
Practice Address - Street 1:830 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-261-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4554207R00000X
IN01069529A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000713226OtherANTHEM
IN201019770Medicaid
INP00955498OtherR.R. MEDICARE
TX1E5020OtherTX MEDICARE
OH3149293Medicaid