Provider Demographics
NPI:1164518114
Name:RASCH, MICHAEL W (CPO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:RASCH
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1691 GALISTEO STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA
Mailing Address - State:FE
Mailing Address - Zip Code:87505
Mailing Address - Country:UM
Mailing Address - Phone:505-820-2390
Mailing Address - Fax:505-820-2392
Practice Address - Street 1:1691 GALISTEO ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4780
Practice Address - Country:US
Practice Address - Phone:505-820-2390
Practice Address - Fax:505-820-2392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DECPO 1456225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84927054Medicaid
NM5122720002Medicare PIN