MEDICARE: DR. ANKEM RAVINDRA 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	207R00000X	Internal Medicine Physician	ME38632	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110131270	OTHER		RR MEDICARE

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	:	1427094242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANKEM RAVINDRA MD

Provider Business Mailing Address
First Line	:	1740 W US HWY 90
Second Line	:	STE 101
City	:	LAKE CITY
State	:	FL
Zip	:	32055
Country	:	US
Telephone Number	:	386-752-3400
Fax Number	:	386-752-3110

Provider Business Practice Location Address
First Line	:	1740 W US HWY 90
Second Line	:	STE 101
City	:	LAKE CITY
State	:	FL
Zip	:	32055
Country	:	US
Telephone Number	:	386-752-3400
Fax Number	:	386-752-3110

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	12/18/2009

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