Provider Demographics
NPI:1710003124
Name:JOHN B RASOR D O P C
Entity Type:Organization
Organization Name:JOHN B RASOR D O P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RASOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-227-2767
Mailing Address - Street 1:7960 GRAND RIVER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7960 GRAND RIVER RD STE 160
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7331
Practice Address - Country:US
Practice Address - Phone:810-227-2767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJR009380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1402941Medicaid
MI1402941Medicaid
MIE78156Medicare UPIN
MI1402941Medicaid