Provider Demographics
NPI:1215962493
Name:RICARDO M. BUENAVENTURA, M.D.,LLC
Entity type:Organization
Organization Name:RICARDO M. BUENAVENTURA, M.D.,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUENAVENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-395-1300
Mailing Address - Street 1:7244 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4207
Mailing Address - Country:US
Mailing Address - Phone:937-395-1300
Mailing Address - Fax:937-395-1311
Practice Address - Street 1:3490 FAR HILLS AVE
Practice Address - Street 2:STE 202
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2500
Practice Address - Country:US
Practice Address - Phone:937-395-1300
Practice Address - Fax:937-395-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-069740207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9333841Medicare ID - Type Unspecified