Basic Information
| Provider Information | |||||||||
| NPI: | 1174544407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAUCH | ||||||||
| FirstName: | DAREN | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1231 KLEEMANN DR | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617272633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2179355022 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1231 KLEEMANN DR | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617272633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2179355022 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 09/28/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 833120 | 01 | IL | MEDICARE GROUP # | OTHER | CA2264 | 01 | RR GROUP # | OTHER | P00404448 | 01 | RR INDIVIDUAL # | OTHER |