Basic Information
| Provider Information | |||||||||
| NPI: | 1447234539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RASANSKY | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27301 DEQUINDRE RD | ||||||||
| Address2: | SUITE 314 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483994400 | ||||||||
| FaxNumber: | 2483994840 | ||||||||
| Practice Location | |||||||||
| Address1: | 27301 DEQUINDRE RD | ||||||||
| Address2: | SUITE 314 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483994400 | ||||||||
| FaxNumber: | 2483994840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 02/16/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 5101006638 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 700002488 | 01 | MI | RR MEDICARE | OTHER | 1447234539 | 05 | MI | MEDICAID | 700H217350 | 01 | MI | BLUE SHIELD | OTHER | C7017 | 01 | MI | C7017 | OTHER |