Provider Demographics
NPI:1629122734
Name:BISHOP, RONALD MACK (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MACK
Last Name:BISHOP
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 1:239 N STATE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9075
Mailing Address - Country:US
Mailing Address - Phone:989-720-5400
Mailing Address - Fax:989-725-7802
Practice Address - Street 1:239 N STATE RD STE 102
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9075
Practice Address - Country:US
Practice Address - Phone:989-720-5400
Practice Address - Fax:989-725-7802
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010813174400000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383694638OtherTAX ID
MI4626474Medicaid
MIE78161Medicare UPIN
MI4626474Medicaid