Provider Demographics
NPI:1407890346
Name:RANKL, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:RANKL
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 1:9099 E LANSING RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1083
Mailing Address - Country:US
Mailing Address - Phone:989-288-2651
Mailing Address - Fax:989-288-2087
Practice Address - Street 1:9099 E LANSING RD
Practice Address - Street 2:SUITE A
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1083
Practice Address - Country:US
Practice Address - Phone:989-288-2651
Practice Address - Fax:989-288-2087
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRR044888OtherBCBS
MI4604252Medicaid
MIN69170024Medicare ID - Type Unspecified
MI4604252Medicaid