Healthcare Provider Details

I. General information

NPI: 1972178820
Provider Name (Legal Business Name): KAUSHIK RAVIPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

5994 SW BALD EAGLE DR
PALM CITY FL
34990-8854
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-3957
  • Fax:
Mailing address:
  • Phone: 561-459-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2021018679
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: