# SUBHASCHANDRA R RAVI MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285948463
- **Authorized official:** MRS. PRABHA REDDY RAVI (OFFICE MANAGER)
- **Authorized official phone:** (269) 621-2166

## Contact information

- **Practice address:** 30 W MAIN ST, HARTFORD, MI 49057-1005
- **Practice address phone:** (269) 621-2166
- **Practice address fax:** (269) 621-2566
- **Mailing address:** 30 W MAIN ST, HARTFORD, MI 49057-8730
- **Mailing address phone:** (269) 621-2166
- **Mailing address fax:** (269) 621-2566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301037460 | MI | Yes |

## Other

- **Enumeration date:** 07/30/2010
- **Last updated:** 07/30/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1790118 | — | MI |