MEDICARE: JAYANTHI M RAVI 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	207K00000X	Allergy & Immunology Physician	ME0048846	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07645	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528053907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYANTHI M RAVI MD

Provider Business Mailing Address
First Line	:	9111 WOODBREEZE BLVD
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-8824
Country	:	US
Telephone Number	:	407-876-1368
Fax Number	:

Provider Business Practice Location Address
First Line	:	9111 WOODBREEZE BLVD
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-8824
Country	:	US
Telephone Number	:	407-876-1368
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/15/2010

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