Provider Demographics
NPI:1265441687
Name:BISSETT, RONALD H (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:BISSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3409 LUDINGTON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-4212
Mailing Address - Country:US
Mailing Address - Phone:906-428-5403
Mailing Address - Fax:906-789-4430
Practice Address - Street 1:3401 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1300
Practice Address - Country:US
Practice Address - Phone:906-786-5707
Practice Address - Fax:906-786-4004
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4178698Medicaid
MI0210016OtherBCBS PIN
MIB45199Medicare UPIN