Provider Demographics
NPI:1669797494
Name:JOSE, RANEEV (MD)
Entity type:Individual
Prefix:DR
First Name:RANEEV
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RANEEV
Other - Middle Name:
Other - Last Name:EPHREM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:248-354-4180
Practice Address - Street 1:IHA HOSPITAL MEDICINE SERVICES
Practice Address - Street 2:5301 E HURON RIVER DRIVE
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-8676
Practice Address - Fax:248-354-4807
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301090250OtherLICENSE
MI110F336360OtherBCBSM
MI1669797494Medicaid
MI4301090250OtherLICENSE
MIFJ1908815OtherDEA