Provider Demographics
NPI:1053503078
Name:RAK PLASTIC AND RECONSTRUCTIVE SURGERY INC
Entity Type:Organization
Organization Name:RAK PLASTIC AND RECONSTRUCTIVE SURGERY INC
Other - Org Name:THOMAS P. RAK, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-399-9997
Mailing Address - Street 1:415 E HOME RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2708
Mailing Address - Country:US
Mailing Address - Phone:937-399-9997
Mailing Address - Fax:937-399-5633
Practice Address - Street 1:415 E HOME RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2708
Practice Address - Country:US
Practice Address - Phone:937-399-9997
Practice Address - Fax:937-399-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-069331208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0207029Medicaid
OH0844861Medicare PIN
G22896Medicare UPIN