Provider Demographics
NPI:1770566630
Name:RALLS, MICHAEL TODD (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TODD
Last Name:RALLS
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:407 S WHITE ST
Mailing Address - Street 2:DIRECTOR OF ANESTHESIA
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2263
Mailing Address - Country:US
Mailing Address - Phone:319-385-6167
Mailing Address - Fax:319-385-6754
Practice Address - Street 1:407 S WHITE ST
Practice Address - Street 2:DIRECTOR OF ANESTHESIA
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2263
Practice Address - Country:US
Practice Address - Phone:319-385-6167
Practice Address - Fax:319-385-6754
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAD133382367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03477701Medicaid
LA1754870Medicaid
TX00C06UOtherBLUE CROSS BLUE SHIELD
MS03477701Medicaid
LA1754870Medicaid