MEDICARE: GERALD A. RAHN, MD., LLC

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	207X00000X	Orthopaedic Surgery Physician	01031820	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000507206	OTHER	IN	BCBS
2	1225060940	OTHER	IN	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1942412168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD A. RAHN, MD., LLC

Provider Business Mailing Address
First Line	:	417 W 6TH ST
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47404-3915
Country	:	US
Telephone Number	:	812-334-1333
Fax Number	:	812-334-1444

Provider Business Practice Location Address
First Line	:	822 W 1ST ST
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-2384
Country	:	US
Telephone Number	:	812-337-1000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GERALD A RAHN
Credential	:	MD
Telephone Number	:	812-334-1333

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	03/25/2008

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