MEDICARE: RAHUL RAUT

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	251B00000X	Case Management Agency	1477117600027	MN

General Provider Information

NPI Number	:	1700622016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHUL RAUT

Provider Business Mailing Address
First Line	:	324 7TH AVE S APT 202
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-1306
Country	:	US
Telephone Number	:	320-443-4969
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 7TH AVE S APT 202
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-1306
Country	:	US
Telephone Number	:	320-443-4969
Fax Number	:

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

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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