Provider Demographics
NPI:1902891310
Name:RANGITSCH, MARK RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:RANGITSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 HOUSE AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3179
Mailing Address - Country:US
Mailing Address - Phone:307-632-9261
Mailing Address - Fax:307-634-9170
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3179
Practice Address - Country:US
Practice Address - Phone:307-632-9261
Practice Address - Fax:307-634-9170
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5525A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY109751200Medicaid
WY82001A003OtherTRICARE
WY303686OtherBLUE CROSS BLUE SHIELD
200020236OtherRAILROAD MEDICARE
WY303686OtherBLUE CROSS BLUE SHIELD
200020236OtherRAILROAD MEDICARE