Provider Demographics
NPI:1336110592
Name:RATANAPANICHKICH, PITI (MD)
Entity Type:Individual
Prefix:DR
First Name:PITI
Middle Name:
Last Name:RATANAPANICHKICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1886 W AUBURN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3865
Mailing Address - Country:US
Mailing Address - Phone:248-290-3111
Mailing Address - Fax:248-290-3100
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:STE 290
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098
Practice Address - Country:US
Practice Address - Phone:248-267-5010
Practice Address - Fax:248-267-5011
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301079313207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4448274Medicaid
G89677Medicare UPIN
MIM54550010Medicare ID - Type Unspecified