Provider Demographics
NPI:1679551618
Name:RANK, BRUCE HENRY (DO)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HENRY
Last Name:RANK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 5650
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1264
Mailing Address - Country:US
Mailing Address - Phone:937-294-3611
Mailing Address - Fax:937-294-9010
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 5650
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-294-3611
Practice Address - Fax:937-294-9010
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002879208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0559435Medicaid
OH0550033Medicare PIN
OHH217991Medicare PIN
OH0559435Medicaid