Healthcare Provider Details

I. General information

NPI: 1083837736
Provider Name (Legal Business Name): BRENT J RAAP DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 12/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4293 N HURON ROAD
PINCONNING MI
48650
US

IV. Provider business mailing address

4293 N HURON ROAD
PINCONNING MI
48650
US

V. Phone/Fax

Practice location:
  • Phone: 989-879-6244
  • Fax: 989-879-1092
Mailing address:
  • Phone: 989-879-6244
  • Fax: 989-879-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013384
License Number StateMI

VIII. Authorized Official

Name: BRENT J RAAP
Title or Position: DOCTOR
Credential: DO
Phone: 989-879-6244