MEDICARE: JAMES E RANOCHAK MD

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	01026732A	IN

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

General Provider Information

NPI Number	:	1972504157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES E RANOCHAK MD

Provider Business Mailing Address
First Line	:	3488B STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4630
Country	:	US
Telephone Number	:	260-241-5807
Fax Number	:	260-486-8075

Provider Business Practice Location Address
First Line	:	3488B STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4630
Country	:	US
Telephone Number	:	260-241-5807
Fax Number	:	260-486-8075

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/22/2015

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