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General NPI Number Information
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NPI Number | 1427380823
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Entity Type | Organization
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Legal Business Name | ANKEM RAVINDRA MD PA
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 1211 SW BASCOM NORRIS DR
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City | LAKE CITY
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State | FL
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Zip | 32025-4916
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Country | US
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Telephone | 386-752-3400
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Fax | 386-752-3110
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Provider Business Mailing Address
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Address Line | 1211 SW BASCOM NORRIS DR
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City | LAKE CITY
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State | FL
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Zip | 32025-4916
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Country | US
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Telephone | 386-752-3400
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Fax | 386-752-3110
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LAURIE A HOLLAND
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Credential |
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Telephone | 352-362-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME38632
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License Number State | FL
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