Basic Information
| Provider Information | |||||||||
| NPI: | 1083902621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNDERKRISHNAN | ||||||||
| FirstName: | RAVI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6770 MAYFIELD RD STE 323 | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441242299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403127140 | ||||||||
| FaxNumber: | 4403127142 | ||||||||
| Practice Location | |||||||||
| Address1: | 6770 MAYFIELD RD STE 323 | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441242299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403127140 | ||||||||
| FaxNumber: | 4403127142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2011 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT198561 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0200X | 35.130526 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.