MEDICARE: RAVI MOHANKA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204F00000X	Transplant Surgery Physician	68904	TN
2	174400000X	Specialist	MT187650	PA
3	208600000X	Surgery Physician	68904	TN

General Provider Information

NPI Number	:	1043415490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI MOHANKA MD

Provider Business Mailing Address
First Line	:	1211 UNION AVE STE 330
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 UNION AVE, 4 SHORB TOWER
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104
Country	:	US
Telephone Number	:	901-478-9183
Fax Number	:	901-478-8957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2007
Last Update Date	:	03/12/2026

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Directions to “ RAVI MOHANKA MD” Practice Location

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