Provider Demographics
NPI:1396844700
Name:RATTIN, CHRISTINE MARGARET (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARGARET
Last Name:RATTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:JACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-828-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39079207RC0000X
MO2004023923207RC0000X
WI21376-875207RC0000X
MI5101012398207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10001769200OtherCOMMUNITY HEALTH PLAN
OK200444510AMedicaid
MO203715016Medicaid
SC390794Medicaid
SC390794Medicaid
OKOKA105293Medicare UPIN
MO701D413Medicare ID - Type Unspecified
OK200444510AMedicaid