Healthcare Provider Details

I. General information

NPI: 1982138012
Provider Name (Legal Business Name): LAURA RAUSCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2017
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5 E 14TH PL APT 504
CHICAGO IL
60605-2920
US

V. Phone/Fax

Practice location:
  • Phone: 773-701-6169
  • Fax:
Mailing address:
  • Phone: 641-330-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.169027
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: