Provider Demographics
NPI:1104929686
Name:RALPH, MICHAEL RAY (AUDIOLOGIST MS CCCA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:RALPH
Suffix:
Gender:M
Credentials:AUDIOLOGIST MS CCCA
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Mailing Address - Street 1:2320 S TIBBS AVENUE
Mailing Address - Street 2:STE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4801
Mailing Address - Country:US
Mailing Address - Phone:317-486-1936
Mailing Address - Fax:317-486-1937
Practice Address - Street 1:2320 S TIBBS AVENUE
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4801
Practice Address - Country:US
Practice Address - Phone:317-486-1936
Practice Address - Fax:317-486-1937
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN23001921231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INAN15840270001OtherCIGNA
IN000000201103OtherANTHEM BLUE CROSS
IN000000093067OtherANTHEM BLUE CROSS
IN000000201103OtherANTHEM BLUE CROSS