Individual
REVATHI REENA RAMANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2622 LAKE AVE, FORT WAYNE, IN 46805-5410
(260) 425-3752
(260) 745-1321
Mailing address
2622 LAKE AVE, FORT WAYNE, IN 46805-5410
(260) 425-3752
(260) 745-1321
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1058613A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200852640
—
IN
Enumeration date
01/16/2007
Last updated
03/13/2015
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