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General NPI Number Information
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NPI Number | 1295475002
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Entity Type | Individual
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Provider Name | RAVEENA SARASWATHI BOODRAM
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 3901 RAINBOW BLVD # MS 1023
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City | KANSAS CITY
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State | KS
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Zip | 66160-1005
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Country | US
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Telephone | 913-588-6019
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 RAINBOW BLVD # 1023
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City | KANSAS CITY
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State | KS
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Zip | 66160-8500
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Country | US
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Telephone | 913-588-6019
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Fax | 913-588-3975
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 94-12093
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License Number State | KS
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