Provider Demographics
NPI:1518048628
Name:RATENER, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RATENER
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 1:2914 DOMINGO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2454
Mailing Address - Country:US
Mailing Address - Phone:510-981-0800
Mailing Address - Fax:510-981-8440
Practice Address - Street 1:2914 DOMINGO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2454
Practice Address - Country:US
Practice Address - Phone:510-981-0800
Practice Address - Fax:510-981-8440
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG4214732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G421473Medicare UPIN
CAA48836Medicare PIN