MEDICARE: RYAN RAUCH

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	207R00000X	Internal Medicine Physician	125.079823	IL

General Provider Information

NPI Number	:	1588303648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN RAUCH

Provider Business Mailing Address
First Line	:	1620 W. HARRISON STREET, CHICAGO, IL 60612
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-942-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 W. HARRISON STREET, CHICAGO, IL 60612
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-942-5000
Fax Number	:

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

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	05/27/2022

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Directions to “ RYAN RAUCH ” Practice Location

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