Healthcare Provider Details

I. General information

NPI: 1275720179
Provider Name (Legal Business Name): RAVI S RANDHAWA DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16244 S MILITARY TRL SUITE 710
DELRAY BEACH FL
33484-6534
US

IV. Provider business mailing address

16244 S MILITARY TRL SUITE 710
DELRAY BEACH FL
33484-6534
US

V. Phone/Fax

Practice location:
  • Phone: 561-638-8505
  • Fax: 561-638-8504
Mailing address:
  • Phone: 561-638-8505
  • Fax: 561-638-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberOS0007402
License Number StateFL

VIII. Authorized Official

Name: MS. PEG SADOWSKI
Title or Position: MANAGER
Credential:
Phone: 561-638-8505