Provider Demographics
NPI:1861419194
Name:KOLAVENTY, RAVINDRA (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:
Last Name:KOLAVENTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAVINDRA
Other - Middle Name:K
Other - Last Name:KOLAVENTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6600 SW HWY 200
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476
Mailing Address - Country:US
Mailing Address - Phone:352-237-4116
Mailing Address - Fax:352-237-1785
Practice Address - Street 1:6600 SW HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476
Practice Address - Country:US
Practice Address - Phone:352-237-4116
Practice Address - Fax:352-237-1785
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80784207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH26245Medicare UPIN
FL51646YMedicare ID - Type UnspecifiedINDIVIDUAL MC PROV #