=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457741373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN B. RASOR D.O, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2015
-----------------------------------------------------
Last Update Date | 01/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7960 W. GRAND RIVER SUITE 160
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-227-2767
-----------------------------------------------------
Fax | 810-227-2760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7960 GRAND RIVER RD SUITE 160
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-7330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-227-2767
-----------------------------------------------------
Fax | 810-227-2760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. MICHELE A RASOR
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 810-227-2767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | 5101009380
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------