Provider Demographics
NPI:1326003575
Name:DUMAN, RALPH J (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:J
Last Name:DUMAN
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 1:500 OSBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1822
Mailing Address - Country:US
Mailing Address - Phone:906-635-4438
Mailing Address - Fax:906-635-4617
Practice Address - Street 1:500 OSBORN BLVD
Practice Address - Street 2:
Practice Address - City:SAULT STE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783
Practice Address - Country:US
Practice Address - Phone:906-635-4438
Practice Address - Fax:906-635-4617
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010505002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00230657OtherRR PTAN
MI4732379Medicaid
MIP00230657OtherRR PTAN P00230657
F42062Medicare UPIN
MIP00230657OtherRR PTAN P00230657