Provider Demographics
NPI:1891888269
Name:RAY, MICHAEL E (MD PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:RAY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E ENTERPRISE
Mailing Address - Street 2:UNIT C
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913
Mailing Address - Country:US
Mailing Address - Phone:920-739-5642
Mailing Address - Fax:920-968-0259
Practice Address - Street 1:900 E GRANT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3487
Practice Address - Country:US
Practice Address - Phone:920-738-6340
Practice Address - Fax:920-738-6435
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010737552085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4537599Medicaid
MI4537599Medicaid
MIH94680Medicare UPIN
MI0H16056057Medicare ID - Type Unspecified