MEDICARE: RATNA K. PALAKODETI 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	207Q00000X	Family Medicine Physician	35-06-1212P	OH
2	207Q00000X	Family Medicine Physician	35.061212	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184679334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RATNA K. PALAKODETI MD

Provider Business Mailing Address
First Line	:	1911 N FAIRFIELD RD
Second Line	:	SUITE 110
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2762
Country	:	US
Telephone Number	:	937-429-1369
Fax Number	:	937-429-4575

Provider Business Practice Location Address
First Line	:	1911 N FAIRFIELD RD
Second Line	:	SUITE 110
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2762
Country	:	US
Telephone Number	:	937-429-1369
Fax Number	:	937-429-4575

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	06/20/2023

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