Provider Demographics
NPI:1043915770
Name:RAVI KRISHNAN MD LLC
Entity type:Organization
Organization Name:RAVI KRISHNAN MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:V
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-449-1540
Mailing Address - Street 1:PO BOX 952060
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0051
Mailing Address - Country:US
Mailing Address - Phone:855-449-1540
Mailing Address - Fax:440-672-5058
Practice Address - Street 1:6559 WILSON MILLS RD STE 106
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3433
Practice Address - Country:US
Practice Address - Phone:855-449-1540
Practice Address - Fax:440-672-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty