Healthcare Provider Details

I. General information

NPI: 1669677142
Provider Name (Legal Business Name): JAIME MARIE RANIERI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 450
INDIANAPOLIS IN
46237-8667
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-7650
  • Fax: 317-528-7645
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME98915
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number01054807A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: