Provider Demographics
NPI:1578519534
Name:MEHAN, RAVI (DO)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:MEHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 NW LAKE WHITNEY PL STE 102
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1618
Mailing Address - Country:US
Mailing Address - Phone:772-344-7228
Mailing Address - Fax:772-344-7158
Practice Address - Street 1:1695 SE INDIAN ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4962
Practice Address - Country:US
Practice Address - Phone:772-301-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99623207R00000X
FLOS8797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266475500Medicaid
FLU0689YMedicare PIN
FLH84437Medicare UPIN
FL266475500Medicaid
FL266475500Medicaid