Provider Demographics
NPI:1306836150
Name:KRISHNAN, RAVI VENKATA (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:VENKATA
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6559 WILSON MILLS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3433
Mailing Address - Country:US
Mailing Address - Phone:855-449-1540
Mailing Address - Fax:440-672-5058
Practice Address - Street 1:6559 WILSON MILLS RD
Practice Address - Street 2:SUITE106
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-6402
Practice Address - Country:US
Practice Address - Phone:855-449-1540
Practice Address - Fax:440-672-5058
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine