Healthcare Provider Details

I. General information

NPI: 1689994964
Provider Name (Legal Business Name): MICHELLE RANES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE KILLION

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 LUCERNE TER 2ND FLOOR MP 818
ORLANDO FL
32806-2014
US

IV. Provider business mailing address

1401 LUCERNE TER 2ND FLOOR MP 818
ORLANDO FL
32806-2014
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-5297
  • Fax: 407-481-0182
Mailing address:
  • Phone: 407-841-5297
  • Fax: 407-481-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME118124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: