Individual
RAVINA V KADAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 MEDICAL DR STE 704, LAGRANGE, GA 30240-4130
(706) 880-7361
Mailing address
303 MEDICAL DRIVE, STE 406, LAGRANGE, GA 30240-4145
(706) 880-7361
(706) 812-2657
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2005037959
MO
207R00000X
Internal Medicine Physician
28388
AL
207R00000X
Internal Medicine Physician
Primary
62902
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200455004
—
MO
01
—
202193
BLUE SHIELD/BLUE CHOICE
MO
01
—
732685
HEALTHLINK
MO
01
—
P00310560
RR MEDICARE
MO
Enumeration date
04/12/2006
Last updated
10/07/2019
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