Healthcare Provider Details

I. General information

NPI: 1336110592
Provider Name (Legal Business Name): PITI RATANAPANICHKICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 INVESTMENT DR STE 290
TROY MI
48098
US

IV. Provider business mailing address

1886 W AUBURN RD SUITE 400
ROCHESTER HILLS MI
48309-3865
US

V. Phone/Fax

Practice location:
  • Phone: 248-267-5010
  • Fax: 248-267-5011
Mailing address:
  • Phone: 248-290-3111
  • Fax: 248-290-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301079313
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: