Provider Demographics
NPI:1982730214
Name:KANCHA, RAVI KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:KUMAR
Last Name:KANCHA
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 1:13241 BARTRAM PARK BLVD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5237
Mailing Address - Country:US
Mailing Address - Phone:904-683-9000
Mailing Address - Fax:904-400-6801
Practice Address - Street 1:13241 BARTRAM PARK BLVD
Practice Address - Street 2:SUITE 413
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5237
Practice Address - Country:US
Practice Address - Phone:904-244-7024
Practice Address - Fax:904-244-4799
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2776391-00Medicaid
FLP00385781OtherRAILROAD MEDICARE
0-596-200-6OtherECFMG
GA533032703AMedicaid
FLI70741Medicare UPIN
GA533032703AMedicaid