Provider Demographics
NPI:1538160536
Name:MADASU, RAVI K (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:K
Last Name:MADASU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40921
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-0921
Mailing Address - Country:US
Mailing Address - Phone:901-681-9895
Mailing Address - Fax:901-377-3633
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-681-9895
Practice Address - Fax:901-377-3633
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36543207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3876048Medicaid
TN3876048Medicare PIN
TN3876048Medicaid
TN38760432Medicare PIN
TNH67961Medicare UPIN