Healthcare Provider Details

I. General information

NPI: 1982357687
Provider Name (Legal Business Name): LORAN A RAKOVICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

IV. Provider business mailing address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4000
  • Fax: 608-824-4100
Mailing address:
  • Phone: 608-824-4000
  • Fax: 608-824-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84171-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number84171-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: