Provider Demographics
NPI:1174611214
Name:RANCOUR, NANCY J (DO)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:RANCOUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4036
Mailing Address - Country:US
Mailing Address - Phone:734-427-3500
Mailing Address - Fax:734-427-7260
Practice Address - Street 1:9216 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4036
Practice Address - Country:US
Practice Address - Phone:734-427-3500
Practice Address - Fax:734-427-7260
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1839881Medicaid
E33115Medicare UPIN
OH27968003Medicare ID - Type Unspecified