Provider Demographics
NPI:1043622095
Name:RAUH, JENNALEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNALEE
Middle Name:
Last Name:RAUH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2725
Mailing Address - Country:US
Mailing Address - Phone:419-225-2726
Mailing Address - Fax:419-228-9909
Practice Address - Street 1:220 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2229
Practice Address - Country:US
Practice Address - Phone:419-586-7874
Practice Address - Fax:419-586-2776
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003771213ER0200X, 213ES0000X, 213ES0103X, 213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2348856Medicaid
OHCB6624OtherRAILROAD MEDICARE
OH0226865Medicaid
OHQ00033069OtherRAILROAD MEDICARE