Individual
RAVISANKAR R BOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20455 LORAIN RD, SECOND FLOOR, FAIRVIEW PARK, OH 44126-3494
(440) 333-8600
(440) 333-5015
Mailing address
6000 W CREEK RD STE 10, INDEPENDENCE, OH 44131-2139
(800) 223-2273
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35059503B
OH
207RI0011X
Interventional Cardiology Physician
Primary
35059503
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10788832
CAQH
—
Enumeration date
03/07/2006
Last updated
09/13/2016
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