Provider Demographics
NPI:1326055864
Name:RANEY, MICHELE EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:EILEEN
Last Name:RANEY
Suffix:
Gender:F
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:PO BOX 60790
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91116-6790
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:39700 BOB HOPE DR # 300-A
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3267
Practice Address - Country:US
Practice Address - Phone:760-346-7696
Practice Address - Fax:760-340-5156
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36853207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G368530OtherBLUE SHIELD
CA00G368531Medicaid
CA00G368531Medicaid
CA00G368531Medicare PIN
CACA134319Medicare PIN
CA00G368530OtherBLUE SHIELD
CAG36853BMedicare PIN
CACK930AMedicare PIN
CACK930CMedicare PIN
CAZZZ34009ZMedicare PIN
CA00G368530OtherBLUE SHIELD