Provider Demographics
NPI:1275625147
Name:KAWAUCHI, RONALD H (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:KAWAUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N SHIAWASSEE ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1632
Mailing Address - Country:US
Mailing Address - Phone:989-729-4673
Mailing Address - Fax:989-725-2617
Practice Address - Street 1:721 N SHIAWASSEE ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1632
Practice Address - Country:US
Practice Address - Phone:989-729-4673
Practice Address - Fax:989-725-2617
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102026207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275625147Medicaid
IN200030710Medicaid
FL830007058OtherRR MEDICARE
FLE4551Y - TPAMedicare PIN
INM400046378Medicare PIN
FLE4551Z - ZHMedicare PIN
IN200030710Medicaid