Provider Demographics
NPI:1154362929
Name:RAVAL, SHILPA B (MD)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:B
Last Name:RAVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1205 PROVIDENT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3265
Mailing Address - Country:US
Mailing Address - Phone:574-269-8383
Mailing Address - Fax:574-269-8384
Practice Address - Street 1:1205 PROVIDENT DR
Practice Address - Street 2:SUITE A
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3265
Practice Address - Country:US
Practice Address - Phone:574-269-8383
Practice Address - Fax:574-269-8384
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2014-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01061146A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200539520Medicaid
IN200539520Medicaid
IN911080G9Medicare PIN