Provider Demographics
NPI:1538365325
Name:RAVEN, RAMIN ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:RAMIN
Middle Name:ALEXANDER
Last Name:RAVEN
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 1:2100 SOLAR DR 100
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0647
Mailing Address - Country:US
Mailing Address - Phone:805-988-9000
Mailing Address - Fax:805-988-9089
Practice Address - Street 1:2799 WEST GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089741207R00000X
CAA119240207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301089741OtherMEDICAL LICENSE NUMBER
CAA119240OtherMEDICAL LICENSE
MI4301089741OtherMEDICAL LICENSE NUMBER