Provider Demographics
NPI:1376722025
Name:RAU, MARK ALLEN (HEARING AID SPECIALI)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:RAU
Suffix:
Gender:M
Credentials:HEARING AID SPECIALI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 LONDON ROAD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6730
Mailing Address - Country:US
Mailing Address - Phone:715-832-5650
Mailing Address - Fax:715-835-5669
Practice Address - Street 1:2430 LONDON ROAD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6730
Practice Address - Country:US
Practice Address - Phone:715-832-5650
Practice Address - Fax:715-835-5669
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1210060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42839900OtherMEDICAL PROGRAM BILLING P