Provider Demographics
NPI:1265265789
Name:JOSEPH, RANIA ADAM
Entity type:Individual
Prefix:
First Name:RANIA
Middle Name:ADAM
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25457 PATRICIA AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1560
Mailing Address - Country:US
Mailing Address - Phone:248-991-7763
Mailing Address - Fax:
Practice Address - Street 1:25457 PATRICIA AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1560
Practice Address - Country:US
Practice Address - Phone:248-991-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM326730319467172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty