Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 01046839A | IN |
NPI | 1114992237 |
---|---|
Provider Name | Dr. Ravishankar Vedantam |
First Address | Muncie, IN 47308-1643 |
Second Address | Richmond, IN 47374-1156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 06/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200138760 | (05) | IN |
2060719 | (05) | OH |
G59191 | (02) |