Provider Demographics
NPI:1780678110
Name:RAAP, BRENT J (DO)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:J
Last Name:RAAP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4293 N HURON RD
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650-8402
Mailing Address - Country:US
Mailing Address - Phone:989-879-6244
Mailing Address - Fax:919-879-6211
Practice Address - Street 1:4293 N HURON RD
Practice Address - Street 2:
Practice Address - City:PINCONNING
Practice Address - State:MI
Practice Address - Zip Code:48650-8402
Practice Address - Country:US
Practice Address - Phone:989-879-6244
Practice Address - Fax:919-879-6211
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7178211OtherAETNA HEALTHCARE
P00163109OtherRAILROAD MEDICARE
MI5091012OtherBLUE CROSS
MI0998243OtherHEALTH PLUS
MI4603193Medicaid
MIN89710001Medicare ID - Type Unspecified
MI4603193Medicaid