Provider Demographics
NPI:1154356194
Name:RANNO, MICHELE A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:A
Last Name:RANNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 POST ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:203-254-2046
Mailing Address - Fax:203-254-2048
Practice Address - Street 1:1305 POST ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824
Practice Address - Country:US
Practice Address - Phone:203-254-2046
Practice Address - Fax:203-254-2048
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004187812Medicaid
CT001368829Medicaid
CT001368829Medicaid