Basic Information
| Provider Information | |||||||||
| NPI: | 1679542120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAVI | ||||||||
| FirstName: | LINGAMURTHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7096 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952670096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099567725 | ||||||||
| FaxNumber: | 2099567733 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 S FAIRMONT AVE | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952405113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093397625 | ||||||||
| FaxNumber: | 2093397419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C54849 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | C54849 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 37483 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 01066183A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 41191 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | C54849 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | C54849 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 208M00000X | C54849 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 6407843900 | 05 | KY | MEDICAID | 000000696138 | 01 | IN | ANTHEM PROVIDER NUMBER / TIN 35-2030653 | OTHER | 200878960 | 05 | IN | MEDICAID | 357400 | 01 | KY | ANTHEM BCBS | OTHER | 000000518675 | 01 | KY | ANTHEM (CHS INC - PPCC) | OTHER |