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General NPI Number Information
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NPI Number | 1215974936
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Entity Type | Organization
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Legal Business Name | PORTER COUNTY ANESTHESIA ASSOCIATES PC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 85 E US HIGHWAY 6
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City | VALPARAISO
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State | IN
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Zip | 46383-8947
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Country | US
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Telephone | 219-983-5743
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Fax | 219-983-5994
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Provider Business Mailing Address
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Address Line | PO BOX 10806
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City | MERRILLVILLE
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State | IN
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Zip | 46411-0806
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Country | US
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Telephone | 219-983-5743
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Fax | 219-983-5994
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAJA RAVELLA
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Credential | M.D.
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Telephone | 219-983-5743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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