Organization
GREAT LAKES ALLERGY AND ASTHMA CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER MIKE RANTA M.D. (OWNER; PHYSICIAN)
(906) 253-0400
Entity
Organization
Contact information
Practice address
309 W 12TH AVE, SUITE 101, SAULT SAINTE MARIE, MI 49783-2885
(906) 253-0400
Mailing address
309 W 12TH AVE, SUITE 101, SAULT SAINTE MARIE, MI 49783-2885
(906) 253-0400
Taxonomy
Speciality
Code
Description
License number
State
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
4301082835
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4609268
—
MI
Enumeration date
11/27/2007
Last updated
02/25/2008
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