Basic Information
| Provider Information | |||||||||
| NPI: | 1245550235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAUBENOLT | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 S KALAMAZOO MALL STE 204 | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490074869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693433900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 S KALAMAZOO MALL STE 204 | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490074869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693433900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 07/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4301096220 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | 4301096220 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.