Provider Demographics
NPI:1457741373
Name:JOHN B. RASOR D.O, P.C.
Entity Type:Organization
Organization Name:JOHN B. RASOR D.O, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:810-227-2767
Mailing Address - Street 1:7960 GRAND RIVER RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7330
Mailing Address - Country:US
Mailing Address - Phone:810-227-2767
Mailing Address - Fax:810-227-2760
Practice Address - Street 1:7960 W. GRAND RIVER
Practice Address - Street 2:SUITE 160
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:810-227-2767
Practice Address - Fax:810-227-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009380305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization