Healthcare Provider Details

I. General information

NPI: 1477420651
Provider Name (Legal Business Name): MR. UMANGBHAI A RAVAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 GARDEN SPRINGS DR
LEXINGTON KY
40504-3464
US

IV. Provider business mailing address

2001 GARDEN SPRINGS DR
LEXINGTON KY
40504-3464
US

V. Phone/Fax

Practice location:
  • Phone: 859-310-0787
  • Fax:
Mailing address:
  • Phone: 859-310-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: