MEDICARE: LEELMOHAN RAVIKUMAR M.D.,

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	207Q00000X	Family Medicine Physician	35.122051	OH

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	:	1881903656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEELMOHAN RAVIKUMAR M.D.,

Provider Business Mailing Address
First Line	:	PO BOX 600
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-0600
Country	:	US
Telephone Number	:	937-283-9699
Fax Number	:	937-283-9839

Provider Business Practice Location Address
First Line	:	998 S DORSET RD STE 301
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-4748
Country	:	US
Telephone Number	:	937-339-9865
Fax Number	:	937-339-6668

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	07/21/2022

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