MEDICARE: DR. RAVIKUMAR R PEDDIREDDY 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	4301058453	MI

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	:	1710989546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAVIKUMAR R PEDDIREDDY MD

Provider Business Mailing Address
First Line	:	G1071 N BALLENGER HWY
Second Line	:	SUITE 206
City	:	FLINT
State	:	MI
Zip	:	48504-4453
Country	:	US
Telephone Number	:	810-234-1651
Fax Number	:	810-257-0694

Provider Business Practice Location Address
First Line	:	G1071 N BALLENGER HWY
Second Line	:	SUITE 206
City	:	FLINT
State	:	MI
Zip	:	48504-4453
Country	:	US
Telephone Number	:	810-234-1651
Fax Number	:	810-257-0694

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/12/2012

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