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General NPI Number Information
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NPI Number | 1225790793
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Entity Type | Individual
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Provider Name | LIZABETH RALLES MD
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Gender | Female
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 13924 WADAGA RD
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City | BARAGA
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State | MI
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Zip | 49908-9204
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Country | US
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Telephone | 715-492-8454
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Fax |
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Provider Business Mailing Address
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Address Line | N10601 CEDAR LN
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City | IRONWOOD
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State | MI
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Zip | 49938-9619
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Country | US
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Telephone | 715-492-8454
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301055482
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License Number State | MI
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