Provider Demographics
NPI:1437101888
Name:RANUM, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RANUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 COUNTRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1528
Mailing Address - Country:US
Mailing Address - Phone:701-255-3070
Mailing Address - Fax:
Practice Address - Street 1:200 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5675
Practice Address - Country:US
Practice Address - Phone:701-222-3937
Practice Address - Fax:701-751-3550
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND680152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1437101888OtherBCBS
MT1437101888Medicaid
SD1437101888Medicaid
1437101888OtherMEDICA
ND893195OtherBCBS & NDVSI
P00802816OtherRAILROAD MEDICARE
ND60672Medicaid
1437101888OtherMEDICA
MT1437101888Medicaid