Healthcare Provider Details

I. General information

NPI: 1518053362
Provider Name (Legal Business Name): MICHAEL I RAUCHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD ST. LOUIS VA JOHN COCHRAN DIVISION
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-7030
  • Fax:
Mailing address:
  • Phone: 314-362-7603
  • Fax: 314-362-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number118586
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: