Active NPI
Ravi Kiran Lakkaraju, MD
- Physical Medicine & Rehabilitation Physician
- Bay City, MI
National Provider Identifier
1790775195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- RL077577
- Practice address
- 3190 E Midland Rd
Bay City, MI 48706-2755 - Phone
- (989) 667-6650
- Fax
- (989) 667-6660
- NPI assigned
- Oct 26, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | RL077577 | MI | Primary |
Addresses
Primary practice location
3190 E Midland Rd
Bay City, MI 48706-2755
Mailing address
6022 E Meadow Dr
Bay City, MI 48706-9081
Phone (989) 667-6650
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RL077577 | Other | MI | STATE LICENSE |
| 4442940 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RL077577 | MI | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McLaren Bay Region | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264377600000",
"number": "1790775195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6022 E MEADOW DR",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487069081",
"telephone_number": "989-667-6650",
"fax_number": "989-667-6660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3190 E MIDLAND RD",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487062755",
"telephone_number": "989-667-6650",
"fax_number": "989-667-6660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKKARAJU",
"first_name": "RAVI",
"middle_name": "KIRAN",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-26",
"last_updated": "2010-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MI",
"license": "RL077577",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "RL077577",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4442940",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bay City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.