Provider Demographics
NPI:1578710471
Name:RANCK, MARK CHESTER (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHESTER
Last Name:RANCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7910 W JEFFERSON BLVD STE 110
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4159
Mailing Address - Country:US
Mailing Address - Phone:260-436-4116
Mailing Address - Fax:260-459-2504
Practice Address - Street 1:7910 W JEFFERSON BLVD STE 110
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-436-4116
Practice Address - Fax:260-459-2504
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01072156A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082915Medicaid
MI1578710471Medicaid
IN201160010Medicaid
MI1578710471Medicaid