Basic Information
| Provider Information | |||||||||
| NPI: | 1487847489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALSAMKARI | ||||||||
| FirstName: | RANNIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 MIAMI VALLEY DR | ||||||||
| Address2: | STE 310 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374354263 | ||||||||
| FaxNumber: | 9372989459 | ||||||||
| Practice Location | |||||||||
| Address1: | 2350 MIAMI VALLEY DR | ||||||||
| Address2: | STE 310 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374354263 | ||||||||
| FaxNumber: | 9372989459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 08/15/2014 | ||||||||
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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 | 390200000X | 40670 | KY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0105X | 090945 | OH | Y | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 2869356 | 05 | OH | MEDICAID | 0535844 | 05 | OH | MEDICAID |