Provider Demographics
NPI:1235291774
Name:HAYRYNEN-RAUCH, TERRY SUE (DO)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:SUE
Last Name:HAYRYNEN-RAUCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:HAYRYNEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1414 FAIR AVE, SUITE 285
Mailing Address - Street 2:VA CBOC
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-226-4618
Mailing Address - Fax:906-265-4245
Practice Address - Street 1:1414 W, FAIR AVE, SUITE 285
Practice Address - Street 2:VA MARQUETTE CBOC
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-226-4618
Practice Address - Fax:906-226-5317
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008892174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MITH008892OtherBCBS LICENSE
MI113227288Medicaid
MIP00210568OtherRRMEDICARE
MIP00210568OtherRRMEDICARE
MIA74145Medicare UPIN