Healthcare Provider Details

I. General information

NPI: 1518230671
Provider Name (Legal Business Name): HANGMING RUAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5761 W MAPLE RD
WEST BLOOMFIELD MI
48322-4493
US

IV. Provider business mailing address

19234 WINDRIDGE DR
NORTHVILLE MI
48167-3919
US

V. Phone/Fax

Practice location:
  • Phone: 248-626-6892
  • Fax:
Mailing address:
  • Phone: 248-719-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008978
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: