Provider Demographics
NPI:1396718045
Name:RAVI, SUKANYA (MD)
Entity type:Individual
Prefix:
First Name:SUKANYA
Middle Name:
Last Name:RAVI
Suffix:
Gender:F
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8224 PARK LN STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6021
Practice Address - Country:US
Practice Address - Phone:214-266-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184782411Medicaid
TX184782415Medicaid
TX184782404Medicaid
TX184782423Medicaid
TX184782407Medicaid
TX184782413Medicaid
TX184782424Medicaid
TX184782426Medicaid
TX184782427Medicaid
TX184782402Medicaid
TX184782412Medicaid
TX184782410Medicaid
TX184782417Medicaid
TX184782418Medicaid
TX184782425Medicaid
TX184782405Medicaid
TX184782406Medicaid
TX184782409Medicaid
TX184782419Medicaid
TX184782420Medicaid
TX184782422Medicaid
TX184782403Medicaid
TX184782414Medicaid
TX184782421Medicaid
TX8X2533OtherBCBS
TX184782424Medicaid
TX184782404Medicaid
TX184782402Medicaid