Provider Demographics
NPI:1023022480
Name:RAHALL, RICHARD ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:RAHALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 E MIDLAND RD
Mailing Address - Street 2:R A RAHALL DO
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-684-0607
Mailing Address - Fax:989-684-2143
Practice Address - Street 1:3210 E MIDLAND RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-684-0607
Practice Address - Fax:989-684-2143
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRR007981208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1641000Medicaid
MIP60500OtherBCN
MIRR007981OtherLIC
MIP60500OtherBCN
E26665Medicare UPIN