Basic Information
| Provider Information | |||||||||
| NPI: | 1881903656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAVIKUMAR | ||||||||
| FirstName: | LEELMOHAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 600 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451770600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372839699 | ||||||||
| FaxNumber: | 9372839839 | ||||||||
| Practice Location | |||||||||
| Address1: | 998 S DORSET RD STE 301 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453734748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373399865 | ||||||||
| FaxNumber: | 9373396668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.122051 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0091133 | 05 | OH | MEDICAID |