Healthcare Provider Details

I. General information

NPI: 1295953412
Provider Name (Legal Business Name): DR K RAVILOCHAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 S BROADWAY STE 320
LITTLETON CO
80122-2624
US

IV. Provider business mailing address

7720 S BROADWAY STE 320
LITTLETON CO
80122-2624
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8277
  • Fax: 303-730-1868
Mailing address:
  • Phone: 303-730-8277
  • Fax: 303-730-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMASAMUDRAM RAVILOCHAN
Title or Position: NEUROLOGIST
Credential: M.D.
Phone: 303-730-8277