Individual
PAVITRA RAVISHANKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 257-8000
Mailing address
34367 MIMOSA TER, FREMONT, CA 94555-1811
(510) 579-1119
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
NA
MO
Other
Enumeration date
03/21/2022
Last updated
03/21/2022
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