MEDICARE: JAMES G RAVIN 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	207W00000X	Ophthalmology Physician	032839	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180008104	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000126975	OTHER	OH	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437153178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES G RAVIN MD

Provider Business Mailing Address
First Line	:	2723 S STATE ST
Second Line	:	SUITE 220
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-6188
Country	:	US
Telephone Number	:	877-852-8463
Fax Number	:	734-994-6283

Provider Business Practice Location Address
First Line	:	3000 REGENCY CT
Second Line	:	STE 100
City	:	TOLEDO
State	:	OH
Zip	:	43623-3081
Country	:	US
Telephone Number	:	419-882-2020
Fax Number	:	419-885-8440

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/17/2008

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