Healthcare Provider Details

I. General information

NPI: 1902891310
Provider Name (Legal Business Name): MARK RICHARD RANGITSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOUSE AVE SUITE 505
CHEYENNE WY
82001-3179
US

IV. Provider business mailing address

2301 HOUSE AVE SUITE 505
CHEYENNE WY
82001-3179
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-9261
  • Fax: 307-634-9170
Mailing address:
  • Phone: 307-632-9261
  • Fax: 307-634-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5525A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: