Active NPI
Ravi Kukreja, MD
- Family Medicine Physician
- Bismarck, ND
National Provider Identifier
1659550549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 10574
- Practice address
- 515 E Broadway Ave
Bismarck, ND 58501-4491 - Phone
- (701) 328-9956
- Fax
- (701) 328-9957
- NPI assigned
- Oct 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 10574 | ND | Primary |
Addresses
Primary practice location
515 E Broadway Ave
Bismarck, ND 58501-4491
Mailing address
515 E Broadway Ave
Bismarck, ND 58501-4491
Phone (701) 328-9956
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12083 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10574 | ND | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193616000000",
"number": "1659550549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 E BROADWAY AVE",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585014491",
"telephone_number": "701-328-9956",
"fax_number": "701-328-9957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 E BROADWAY AVE",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585014491",
"telephone_number": "701-328-9956",
"fax_number": "701-328-9957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUKREJA",
"first_name": "RAVI",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-29",
"last_updated": "2007-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "10574",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12083",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.