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General NPI Number Information
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NPI Number | 1275622128
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Entity Type | Individual
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Provider Name | KEMPSAGAR C RAVISHANKAR MD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 7215 OLD OAK BLVD STE A411
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City | CLEVELAND
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State | OH
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Zip | 44130-3334
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Country | US
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Telephone | 440-826-9221
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Fax | 440-816-5399
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Provider Business Mailing Address
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Address Line | 7215 OLD OAK BLVD STE A411
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City | CLEVELAND
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State | OH
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Zip | 44130-3334
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Country | US
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Telephone | 440-826-9221
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Fax | 440-816-5399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 35-068631
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License Number State | OH
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