Healthcare Provider Details

I. General information

NPI: 1922275221
Provider Name (Legal Business Name): DILEEP C. RAVI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 NORTH HARRISON PARKWAY SUITE 200
SUNRISE FL
33323-2853
US

IV. Provider business mailing address

1613 NORTH HARRISON PARKWAY SUITE 200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax: 904-244-4508
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME109392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME109392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: