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NPI Code Detail

MEDICARE: MARYLYN S RANTA M.D.

MEDICARE: MARYLYN S RANTA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician26860WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972598209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYLYN S RANTA M.D.
Provider Business Mailing Address
First Line : 4855 S MOORLAND RD
Second Line : SUITE 150
City : NEW BERLIN
State : WI
Zip : 53151-7401
Country : US
Telephone Number : 414-425-5660
Fax Number : 414-425-9803
Provider Business Practice Location Address
First Line : 4855 S MOORLAND RD
Second Line : SUITE 150
City : NEW BERLIN
State : WI
Zip : 53151-7401
Country : US
Telephone Number : 414-425-5660
Fax Number : 414-425-9803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 09/14/2009

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Directions to “ MARYLYN S RANTA M.D.” Practice Location

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