1396718045 NPI number — SUKANYA RAVI MD

Table of content: SUKANYA RAVI MD (NPI 1396718045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396718045 NPI number — SUKANYA RAVI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAVI
Provider First Name:
SUKANYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396718045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75266-0599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8224 PARK LN STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-266-0350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  M0539 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 184782411 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782415 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782423 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782407 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782413 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782424 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782426 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782427 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782412 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782410 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782417 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782418 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782425 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782409 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782419 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184782420 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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