MEDICARE: DR. RAJANI K RAVINDRA 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	2084P0800X	Psychiatry Physician	ME40806	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010023058	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	237718	OTHER	ARMED
3	088689	OTHER	VALUE OPTIONS
4	12064	OTHER	BCBS

General Provider Information

NPI Number	:	1952347767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJANI K RAVINDRA MD

Provider Business Mailing Address
First Line	:	1740 W US HWY 90
Second Line	:	STE 102
City	:	LAKE CITY
State	:	FL
Zip	:	32055
Country	:	US
Telephone Number	:	386-755-3000
Fax Number	:	386-719-4297

Provider Business Practice Location Address
First Line	:	1740 W US HWY 90
Second Line	:	STE 102
City	:	LAKE CITY
State	:	FL
Zip	:	32055
Country	:	US
Telephone Number	:	386-755-3000
Fax Number	:	386-719-4297

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	12/04/2009

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