Subject Numbers Regarding Health Provider Authorizations

Authorization No. 204656-3B

November 3, 2015

Please be advised that Dr. Miriam Van Opdorp Ragab has resigned her authorizations to treat injured workers and to perform independent medical examinations in the New York State workers’ compensation system effective October 30, 2015. Dr. Ragab’s last known practice addresses are, 1805 Golf View Drive, Buffalo, Minnesota, Buffalo Hospital, 303 Catlin Street, Buffalo, Minnesota 55313, and 110 Olsen Boulevard Ne, Suite 520, Cokato, Minnesota 55321.

Dr. Ragab is prohibited from rendering treatment and care to injured workers and from performing independent medical examinations. Reports submitted by Dr. Ragab for services rendered prior to October 30, 2015, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Ragab for services rendered prior to October 30, 2015, should not be denied due to the resignation of her authorizations.

Any questions regarding the authorized lists should be referred to the Medical Director’s Office at 1 (800) 781-2362.