Provider Demographics
NPI:1083711105
Name:RAICH, ALLEN K (DPM)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:K
Last Name:RAICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 POPLAR VIEW LN N STE 2
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9339
Mailing Address - Country:US
Mailing Address - Phone:901-853-3015
Mailing Address - Fax:901-853-3015
Practice Address - Street 1:1121 POPLAR VIEW LN N STE 2
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9339
Practice Address - Country:US
Practice Address - Phone:901-853-3015
Practice Address - Fax:901-853-3015
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNDPM228213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621362430OtherTAX ID
TN4106735OtherBLUE SHIELD
TN3351106Medicaid
TNP00276068OtherRAILROAD MEDICARE
TN3351106Medicaid
TN4106735OtherBLUE SHIELD
TN6138160001Medicare NSC