MEDICARE: BRENT J RAAP DO

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	207Q00000X	Family Medicine Physician	5101013384	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00163109	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7178211	OTHER		AETNA HEALTHCARE
3	5091012	OTHER	MI	BLUE CROSS
4	0998243	OTHER	MI	HEALTH PLUS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780678110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT J RAAP DO

Provider Business Mailing Address
First Line	:	4293 N HURON RD
Second Line	:
City	:	PINCONNING
State	:	MI
Zip	:	48650-8402
Country	:	US
Telephone Number	:	989-879-6244
Fax Number	:	919-879-6211

Provider Business Practice Location Address
First Line	:	4293 N HURON RD
Second Line	:
City	:	PINCONNING
State	:	MI
Zip	:	48650-8402
Country	:	US
Telephone Number	:	989-879-6244
Fax Number	:	919-879-6211

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/09/2007

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Directions to “ BRENT J RAAP DO” Practice Location

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