Provider Demographics
NPI:1457380784
Name:RATTER, MICHAEL LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:RATTER
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 868
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-0868
Mailing Address - Country:US
Mailing Address - Phone:909-658-4903
Mailing Address - Fax:
Practice Address - Street 1:3865 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3919
Practice Address - Country:US
Practice Address - Phone:951-352-5666
Practice Address - Fax:951-352-5445
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56347207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G563470Medicaid
CAF09525Medicare UPIN
CA00G563470Medicaid