Provider Demographics
NPI:1174544407
Name:RAUCH, DAREN J (MD)
Entity type:Individual
Prefix:
First Name:DAREN
Middle Name:J
Last Name:RAUCH
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 1:1231 KLEEMANN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2633
Mailing Address - Country:US
Mailing Address - Phone:217-935-5022
Mailing Address - Fax:
Practice Address - Street 1:1231 KLEEMANN DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2633
Practice Address - Country:US
Practice Address - Phone:217-935-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL833120OtherMEDICARE GROUP #
CA2264OtherRR GROUP #
P00404448OtherRR INDIVIDUAL #
ILK39371Medicare PIN
IL833120OtherMEDICARE GROUP #