Provider Demographics
NPI:1083837736
Name:BRENT J RAAP DO PC
Entity Type:Organization
Organization Name:BRENT J RAAP DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAAP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-879-6244
Mailing Address - Street 1:4293 N HURON ROAD
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650
Mailing Address - Country:US
Mailing Address - Phone:989-879-6244
Mailing Address - Fax:989-879-1092
Practice Address - Street 1:4293 N HURON ROAD
Practice Address - Street 2:
Practice Address - City:PINCONNING
Practice Address - State:MI
Practice Address - Zip Code:48650
Practice Address - Country:US
Practice Address - Phone:989-879-6244
Practice Address - Fax:989-879-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N89710Medicare ID - Type Unspecified