Healthcare Provider Details

I. General information

NPI: 1255340063
Provider Name (Legal Business Name): RONALD A RONQUIST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR SUITE 1
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

894 CAMPUS DR SUITE B
HANCOCK MI
49930-1644
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1040
  • Fax: 906-483-1270
Mailing address:
  • Phone: 906-483-1445
  • Fax: 906-483-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301051494
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: