Provider Demographics
NPI:1669677142
Name:RANIERI, JAIME MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MARIE
Last Name:RANIERI
Suffix:
Gender:F
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:8051 S EMERSON AVE STE 450
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8667
Practice Address - Country:US
Practice Address - Phone:317-528-7650
Practice Address - Fax:317-528-7645
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME989152086S0122X
IN01054807A2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA199967659AMedicaid
FL2784360-00Medicaid
GA199967659AMedicaid