Healthcare Provider Details

I. General information

NPI: 1578710471
Provider Name (Legal Business Name): MARK C RANCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 W JEFFERSON BLVD STE 110 SUITE 110
FORT WAYNE IN
46804-4159
US

IV. Provider business mailing address

7910 W JEFFERSON BLVD STE 110 SUITE 110
FORT WAYNE IN
46804-4159
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-4116
  • Fax: 260-459-2504
Mailing address:
  • Phone: 260-436-4116
  • Fax: 260-459-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.140622
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01072156A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: