Provider Demographics
NPI:1346210317
Name:RAMINICK, WILLIAM R (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:RAMINICK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:DEPT 203901
Mailing Address - Street 2:P O BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267
Mailing Address - Country:US
Mailing Address - Phone:248-471-8982
Mailing Address - Fax:248-471-9978
Practice Address - Street 1:23133 ORCHARD LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3268
Practice Address - Country:US
Practice Address - Phone:248-579-9220
Practice Address - Fax:248-471-9978
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010597207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346210317Medicaid
F00570Medicare UPIN
MI1346210317Medicaid