Provider Demographics
NPI:1750335378
Name:RANTA, PETER MIKE (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MIKE
Last Name:RANTA
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 1:309 W 12TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-2885
Mailing Address - Country:US
Mailing Address - Phone:906-253-0400
Mailing Address - Fax:906-253-0401
Practice Address - Street 1:309 W 12TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-2885
Practice Address - Country:US
Practice Address - Phone:906-253-0400
Practice Address - Fax:906-253-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082835207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4609268Medicaid
I06942Medicare UPIN
MI4609268Medicaid