Healthcare Provider Details

I. General information

NPI: 1831184720
Provider Name (Legal Business Name): THEODOR B RAIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 GLENDALE AVE KOBACKER CENTER
TOLEDO OH
43614-5811
US

IV. Provider business mailing address

3900 SUNFOREST CT STE 227
TOLEDO OH
43623-4440
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-3815
  • Fax: 419-383-3098
Mailing address:
  • Phone: 419-724-6567
  • Fax: 419-241-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number278413-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number35076784
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35076784
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35076784
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.076784
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number35.076784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: