Healthcare Provider Details

I. General information

NPI: 1588984702
Provider Name (Legal Business Name): RANI ISSA GEBARA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVENUE STE 520
LANSING MI
48912
US

IV. Provider business mailing address

804 SERVICE RD A201
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5260
  • Fax: 517-364-5251
Mailing address:
  • Phone: 517-884-2976
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2005984
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5101018893
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: