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NPI Code Detail

MEDICARE: RAVISHANKAR B. CHANNAPPA MD

MEDICARE: RAVISHANKAR B. CHANNAPPA 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
1207P00000XEmergency Medicine Physician82031MA
2207P00000XEmergency Medicine PhysicianME136641FL

Other Identifiers

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

General Provider Information

NPI Number : 1700815842
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVISHANKAR B. CHANNAPPA MD
Provider Business Mailing Address
First Line : 8300 RED BUG LAKE RD
Second Line :
City : OVIEDO
State : FL
Zip : 32765-6801
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8300 RED BUG LAKE RD
Second Line :
City : OVIEDO
State : FL
Zip : 32765-6801
Country : US
Telephone Number : 407-890-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 02/09/2023

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