Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 54569 | MN |
N | 208000000X | Pediatrician | 105726 | MN |
N | 208000000X | Pediatrician | 125-55887 | IL |
N | 2080A0000X | Adolescent Medicine | 54569 | MN |
Y | 2080P0201X | Pediatric Allergist | 54569 | MN |
NPI | 1619102068 |
---|---|
Provider Name | Dr. Anupama Ravi |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2009 |
Last Update Date | 19/08/2020 |