Provider Demographics
NPI:1578781399
Name:RASP, MARTIN T (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:T
Last Name:RASP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 MELLISH DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3339
Mailing Address - Country:US
Mailing Address - Phone:810-664-2798
Mailing Address - Fax:
Practice Address - Street 1:401 N HOOPER ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1476
Practice Address - Country:US
Practice Address - Phone:989-673-3141
Practice Address - Fax:989-673-8471
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010065182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4527135Medicaid
MI4527135Medicaid