Healthcare Provider Details

I. General information

NPI: 1679675953
Provider Name (Legal Business Name): RAVINDRA K RAMAKRISHNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 10/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE STE 5008
MIAMI FL
33133-4221
US

IV. Provider business mailing address

8600 SW 92ND ST STE 204A
MIAMI FL
33156-7377
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-0616
  • Fax: 305-854-4384
Mailing address:
  • Phone: 305-216-7312
  • Fax: 305-216-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036110048
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMT198254
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME111379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: