MEDICARE: ANKEM RAVINDRA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME38632	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427380823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANKEM RAVINDRA MD PA

Provider Business Mailing Address
First Line	:	1211 SW BASCOM NORRIS DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-4916
Country	:	US
Telephone Number	:	386-752-3400
Fax Number	:	386-752-3110

Provider Business Practice Location Address
First Line	:	1211 SW BASCOM NORRIS DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-4916
Country	:	US
Telephone Number	:	386-752-3400
Fax Number	:	386-752-3110

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LAURIE A HOLLAND
Credential	:
Telephone Number	:	352-362-4223

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	03/04/2026

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