Provider Demographics
NPI:1467442616
Name:RANA, KETAN G (MD)
Entity Type:Individual
Prefix:
First Name:KETAN
Middle Name:G
Last Name:RANA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1695 12 MILE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2100
Mailing Address - Country:US
Mailing Address - Phone:248-545-6100
Mailing Address - Fax:248-545-6102
Practice Address - Street 1:28963 LITTLE MACK AVE
Practice Address - Street 2:GI MEDICINE ASSOCIATES PC SUITE 101
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3015
Practice Address - Country:US
Practice Address - Phone:586-447-0700
Practice Address - Fax:586-498-0707
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-07-19
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Provider Licenses
StateLicense IDTaxonomies
MI4301066770207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI336774310Medicaid
9630967001OtherCIGNA
P63114OtherBCN
5323513OtherAETNA
P63114OtherBCN
MIOM49130Medicare PIN