MEDICARE: DR. SHOBHA RATNAM 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	207RN0300X	Nephrology Physician	35083691	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	:	1902891591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHOBHA RATNAM M.D.

Provider Business Mailing Address
First Line	:	3355 GLENDALE AVE FL 3
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2426
Country	:	US
Telephone Number	:	419-383-5288
Fax Number	:	419-383-2825

Provider Business Practice Location Address
First Line	:	1125 HOSPITAL DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-8001
Country	:	US
Telephone Number	:	419-383-5288
Fax Number	:	419-383-2825

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	01/16/2018

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