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General NPI Number Information
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NPI Number | 1023244126
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Entity Type | Individual
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Provider Name | ISMAEL ENRIQUE GONZALEZ RANGEL MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 07/15/2023
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Provider Practice Location Address
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Address Line | 43200 DEQUINDRE RD STE 105
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1707
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Country | US
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Telephone | 248-780-9490
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Fax |
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Provider Business Mailing Address
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Address Line | 43200 DEQUINDRE RD STE 105
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1707
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Country | US
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Telephone | 248-780-9490
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Fax | 248-585-8266
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 4301100788
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License Number State | MI
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