Provider Demographics
NPI:1255303053
Name:RAINOSEK, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:RAINOSEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CENTRAL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3507
Mailing Address - Country:US
Mailing Address - Phone:505-265-9542
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR
Practice Address - Street 2:SUITE 355
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2943
Practice Address - Country:US
Practice Address - Phone:907-258-2149
Practice Address - Fax:907-258-2147
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-125207LP2900X, 207L00000X
AK4089207L00000X
SC17057207L00000X
ND7873207L00000X
VA0101053991207L00000X
ARE-1569207L00000X
MOMD114245207L00000X
NY217875207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD40891Medicaid
AKG59899Medicare UPIN
AK153165Medicare ID - Type Unspecified