Provider Demographics
NPI:1841294592
Name:RANTA, JAMES P (DO, MS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:RANTA
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 12 MILE RD NW
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-9754
Mailing Address - Country:US
Mailing Address - Phone:616-391-8470
Mailing Address - Fax:616-391-8495
Practice Address - Street 1:2111 12 MILE RD NW
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-9754
Practice Address - Country:US
Practice Address - Phone:616-391-8470
Practice Address - Fax:616-391-8495
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4195536Medicaid
MIE31578Medicare UPIN
MI4195536Medicaid