Provider Demographics
NPI:1407828676
Name:RAYEL, RAMON RAY GREGORIO (MD)
Entity Type:Individual
Prefix:
First Name:RAMON RAY
Middle Name:GREGORIO
Last Name:RAYEL
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 1:164 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2845 GREENBRIER RD STE 310
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-8300
Practice Address - Fax:920-288-8305
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39472-020207RC0000X, 207RC0000X
MI4301083248207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5206090Medicaid
MI0220121OtherBCBS OF MI
1042616OtherPREFERRED ONE
MI110B210270OtherBCBS
MI4657176Medicaid
MIP00188872OtherRAILROAD MEDICARE
WI32560500Medicaid
WI32560500Medicaid
MI4657176Medicaid
WI025807650Medicare PIN
MIB26002113Medicare PIN
WI40015-0015Medicare ID - Type Unspecified
WI004571460Medicare PIN