Provider Demographics
NPI:1386973733
Name:RKEIN, RANA
Entity type:Individual
Prefix:
First Name:RANA
Middle Name:
Last Name:RKEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 E PECOS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6140
Mailing Address - Country:US
Mailing Address - Phone:480-238-7622
Mailing Address - Fax:480-279-5502
Practice Address - Street 1:3815 PELHAM ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3852
Practice Address - Country:US
Practice Address - Phone:313-722-4683
Practice Address - Fax:313-241-9342
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4590363A00000X
MI5315091344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI831910484Medicaid