Healthcare Provider Details

I. General information

NPI: 1164870655
Provider Name (Legal Business Name): NICHOLAS RAASCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E CRAWFORD ST
SALINA KS
67401-5103
US

IV. Provider business mailing address

737 E CRAWFORD ST
SALINA KS
67401-5103
US

V. Phone/Fax

Practice location:
  • Phone: 785-827-7261
  • Fax: 785-833-5706
Mailing address:
  • Phone: 785-827-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number94-08902
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: