Provider Demographics
NPI:1578632089
Name:POLAVARAPU, RAVINDRA NATH (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:NATH
Last Name:POLAVARAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 STEWART RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-5304
Mailing Address - Country:US
Mailing Address - Phone:734-240-1760
Mailing Address - Fax:734-240-1780
Practice Address - Street 1:700 STEWART RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5304
Practice Address - Country:US
Practice Address - Phone:734-240-1760
Practice Address - Fax:734-240-1780
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010584542084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3476819Medicaid
MI2605800952OtherBCBS
MI3476819Medicaid
MIF75169Medicare UPIN