Provider Demographics
NPI:1871701151
Name:FINE, RONALD E (MD, PHD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:FINE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2512
Mailing Address - Country:US
Mailing Address - Phone:231-946-9613
Mailing Address - Fax:231-946-9613
Practice Address - Street 1:107 E STATE ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2512
Practice Address - Country:US
Practice Address - Phone:231-946-9613
Practice Address - Fax:231-946-9613
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010338942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE16088Medicare UPIN