Healthcare Provider Details

I. General information

NPI: 1861750432
Provider Name (Legal Business Name): RAVI BHASKER PATEL M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 UNIVERSITY AVE APT 311
MADISON WI
53705-2161
US

IV. Provider business mailing address

3326 UNIVERSITY AVE APT 311
MADISON WI
53705-2161
US

V. Phone/Fax

Practice location:
  • Phone: 216-269-1971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number67954-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: