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NPI Code Detail

MEDICARE: RAPHAEL AGBAVITOR MD

MEDICARE: RAPHAEL AGBAVITOR MD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramWI

General Provider Information

NPI Number : 1538009212
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAPHAEL AGBAVITOR MD
Provider Business Mailing Address
First Line : 2927 MARCONI AVE APT 42
Second Line :
City : SACRAMENTO
State : CA
Zip : 95821-5049
Country : US
Telephone Number : 815-971-3314
Fax Number :
Provider Business Practice Location Address
First Line : 849 KELLOGG AVE
Second Line :
City : JANESVILLE
State : WI
Zip : 53546-2808
Country : US
Telephone Number : 815-971-3314
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2026
Last Update Date : 03/31/2026

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