Provider Demographics
NPI:1235316506
Name:EERO J. RANTA, M.D., P.C.
Entity Type:Organization
Organization Name:EERO J. RANTA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EERO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-632-6823
Mailing Address - Street 1:550 OSBORN BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1899
Mailing Address - Country:US
Mailing Address - Phone:906-632-6823
Mailing Address - Fax:906-632-7755
Practice Address - Street 1:550 OSBORN BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1899
Practice Address - Country:US
Practice Address - Phone:906-632-6823
Practice Address - Fax:906-632-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101083198Medicaid
MI0P53380Medicare PIN
MI101083198Medicaid