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General NPI Number Information
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NPI Number | 1538111810
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Entity Type | Individual
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Provider Name | MEDDA MICHELLE RAUHUT MD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 2010 U S HIGHWAY 190 W #143
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City | LIVINGSTON
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State | TX
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Zip | 77351-9601
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Country | US
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Telephone | 936-329-2409
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1880
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City | LIVINGSTON
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State | TX
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Zip | 77351-0035
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Country | US
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Telephone | 936-329-2409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K4785
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | K4785
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License Number State | TX
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