MEDICARE: RAVI KRISHNAN MD LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1043915770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVI KRISHNAN MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 952060
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0051
Country	:	US
Telephone Number	:	855-449-1540
Fax Number	:	440-672-5058

Provider Business Practice Location Address
First Line	:	6559 WILSON MILLS RD STE 106
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3433
Country	:	US
Telephone Number	:	855-449-1540
Fax Number	:	440-672-5068

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	RAVI V KRISHNAN
Credential	:	MD
Telephone Number	:	855-449-1540

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	09/02/2025

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