MEDICARE: KATHLEEN RANKIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5601002656	MI

General Provider Information

NPI Number	:	1487613634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN RANKIN PA-C

Provider Business Mailing Address
First Line	:	4613 W MAIN ST
Second Line	:	SUITE A
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2645
Country	:	US
Telephone Number	:	269-488-8672
Fax Number	:	269-488-8673

Provider Business Practice Location Address
First Line	:	4613 W MAIN ST
Second Line	:	SUITE A
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2645
Country	:	US
Telephone Number	:	269-488-8672
Fax Number	:	269-488-8673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	11/27/2023

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