Provider Demographics
NPI:1952347767
Name:RAVINDRA, RAJANI K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJANI
Middle Name:K
Last Name:RAVINDRA
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 1:1740 W US HWY 90
Mailing Address - Street 2:STE 102
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055
Mailing Address - Country:US
Mailing Address - Phone:386-755-3000
Mailing Address - Fax:386-719-4297
Practice Address - Street 1:1740 W US HWY 90
Practice Address - Street 2:STE 102
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055
Practice Address - Country:US
Practice Address - Phone:386-755-3000
Practice Address - Fax:386-719-4297
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME408062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
010023058OtherRAILROAD MEDICARE
237718OtherARMED
088689OtherVALUE OPTIONS
12064OtherBCBS
088689OtherVALUE OPTIONS
237718OtherARMED