MEDICARE: BRIAN RAUTENBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1811763022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN RAUTENBERG

Provider Business Mailing Address
First Line	:	2369 TART LAKE RD
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55038-7730
Country	:	US
Telephone Number	:	612-482-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2369 TART LAKE RD
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55038-7730
Country	:	US
Telephone Number	:	612-482-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	01/04/2024

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Directions to “ BRIAN RAUTENBERG ” Practice Location

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