Provider Demographics
NPI:1457339111
Name:RANZINGER, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:RANZINGER
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 1:2006 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5232
Mailing Address - Country:US
Mailing Address - Phone:574-535-9100
Mailing Address - Fax:574-535-1020
Practice Address - Street 1:2006 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5232
Practice Address - Country:US
Practice Address - Phone:574-535-9100
Practice Address - Fax:574-535-1020
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065294174400000X
OH35063795207P00000X
IN01065294A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108323Medicaid
IN200909140AMedicaid
OH0108323Medicaid
IN200909140AMedicaid
INE66538Medicare UPIN