Provider Demographics
NPI:1760605364
Name:RANSONE, CAREY BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:BERNARD
Last Name:RANSONE
Suffix:
Gender:M
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 1:8865 W 400 N STE 105
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9223
Practice Address - Country:US
Practice Address - Phone:219-861-8740
Practice Address - Fax:219-877-1029
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045023208800000X
IN01045023A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200091080Medicaid
IN659670Medicare ID - Type Unspecified
IN200091080Medicaid