Healthcare Provider Details

I. General information

NPI: 1477527372
Provider Name (Legal Business Name): JAMES E RAUCHENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 NEW VISION DR
FORT WAYNE IN
46845-1725
US

IV. Provider business mailing address

1234 E DUPONT RD SUITE 3
FORT WAYNE IN
46825-1545
US

V. Phone/Fax

Practice location:
  • Phone: 260-469-6602
  • Fax: 260-969-3065
Mailing address:
  • Phone: 260-373-9700
  • Fax: 260-458-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01057754A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: