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General NPI Number Information
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NPI Number | 1558369132
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Entity Type | Individual
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Provider Name | ASHWIN N RAVAL MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 12611 PENNSYLVANIA RD
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City | RIVERVIEW
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State | MI
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Zip | 48192-4224
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Country | US
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Telephone | 734-285-5280
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Fax | 734-285-6730
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Provider Business Mailing Address
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Address Line | 12611 PENNSYLVANIA RD
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City | RIVERVIEW
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State | MI
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Zip | 48192-4224
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Country | US
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Telephone | 734-285-5280
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Fax | 734-285-6730
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AR035652
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License Number State | MI
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