MEDICARE: INGRID J RACHESKY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	ME0044063	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03618	OTHER	FL	BCBS OF FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154415610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID J RACHESKY M.D.

Provider Business Mailing Address
First Line	:	2550 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405
Country	:	US
Telephone Number	:	850-769-1481
Fax Number	:	850-763-2435

Provider Business Practice Location Address
First Line	:	2550 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405
Country	:	US
Telephone Number	:	850-769-1481
Fax Number	:	850-763-2435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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