Provider Demographics
NPI:1023157773
Name:RAVICHANDRAN, SONAL SHAH (MD)
Entity type:Individual
Prefix:
First Name:SONAL
Middle Name:SHAH
Last Name:RAVICHANDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3022
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:705 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9440
Practice Address - Country:US
Practice Address - Phone:463-234-6400
Practice Address - Fax:463-234-6401
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116777207R00000X
MO2009013986207R00000X
IN01074219A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201309770Medicaid
IN201309770Medicaid
IN177280039Medicare PIN