Healthcare Provider Details

I. General information

NPI: 1275622128
Provider Name (Legal Business Name): KEMPSAGAR C RAVISHANKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 OLD OAK BLVD STE A411
CLEVELAND OH
44130-3334
US

IV. Provider business mailing address

7215 OLD OAK BLVD STE A411
CLEVELAND OH
44130-3334
US

V. Phone/Fax

Practice location:
  • Phone: 440-826-9221
  • Fax: 440-816-5399
Mailing address:
  • Phone: 440-826-9221
  • Fax: 440-816-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number35-068631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: