=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467442616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KETAN G RANA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2005
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28963 LITTLE MACK AVE GI MEDICINE ASSOCIATES PC SUITE 101
-----------------------------------------------------
City | ST CLAIR SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48081-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-447-0700
-----------------------------------------------------
Fax | 586-498-0707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1695 12 MILE RD STE 220
-----------------------------------------------------
City | BERKLEY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48072-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-545-6100
-----------------------------------------------------
Fax | 248-545-6102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 4301066770
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------