1184691826 NPI number — RAVI VAELA M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184691826 NPI number — RAVI VAELA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAELA
Provider First Name:
RAVI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMAKRISHNA
Provider Other First Name:
RAVI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184691826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 S MAPLE ST
Provider Second Line Business Mailing Address:
SUITE 216
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-1760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-442-2191
Provider Business Mailing Address Fax Number:
952-442-8081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 S MAPLE ST
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
WACONIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55387-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-442-2191
Provider Business Practice Location Address Fax Number:
952-442-8081
Provider Enumeration Date:
03/01/2006

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: 207RP1001X , with the licence number:  01051926 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 492478100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com