Healthcare Provider Details

I. General information

NPI: 1619233228
Provider Name (Legal Business Name): RAVI TALATI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # S20
CLEVELAND OH
44195
US

IV. Provider business mailing address

9500 EUCLID AVE # S20
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 164-443-3602
  • Fax:
Mailing address:
  • Phone: 216-444-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number34.013482
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: