Individual
MISS CHARLOTTE BLAIR RANCOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
515 N MICHIGAN AVE, SAGINAW, MI 48602-4316
(989) 798-8252
Mailing address
515 N MICHIGAN AVE, SAGINAW, MI 48602-4316
(517) 583-2853
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5502003992
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JXP913029551
BLUE CROSS BLUE SHIELD
MI
Enumeration date
04/16/2018
Last updated
04/16/2018
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