Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 25MA08146800 | NJ |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME96696 | FL |
NPI | 1265550602 |
---|---|
Provider Name | Dr. Ravishankar N. Koppada |
First Address | Coral Gables, FL 33146-3723 |
Second Address | Coral Gables, FL 33146-3723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 07/09/2011 |