MEDICARE: MR. MICHAEL TODD RALLS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	209034725	IL
2	367500000X	Certified Registered Nurse Anesthetist	D133382	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00C06U	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1770566630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL TODD RALLS CRNA

Provider Business Mailing Address
First Line	:	407 S WHITE ST
Second Line	:	DIRECTOR OF ANESTHESIA
City	:	MT PLEASANT
State	:	IA
Zip	:	52641-2263
Country	:	US
Telephone Number	:	319-385-6167
Fax Number	:	319-385-6754

Provider Business Practice Location Address
First Line	:	407 S WHITE ST
Second Line	:	DIRECTOR OF ANESTHESIA
City	:	MT PLEASANT
State	:	IA
Zip	:	52641-2263
Country	:	US
Telephone Number	:	319-385-6167
Fax Number	:	319-385-6754

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	05/29/2026

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