Provider Demographics
NPI:1003840349
Name:FISHMAN OIKNINE, RACHEL LYNN (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:FISHMAN OIKNINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:SUITE 410N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-469-6224
Mailing Address - Fax:314-469-0744
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 410N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-469-6224
Practice Address - Fax:314-469-0744
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO217339207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11541438OtherCAQH
MO201555OtherBC/BS
MO201555OtherBC/BS
MO934134580Medicare ID - Type Unspecified