Provider Demographics
NPI:1396858460
Name:RAU, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:RAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9907 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9561
Mailing Address - Country:US
Mailing Address - Phone:317-873-4308
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 5837
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-8167
Practice Address - Fax:317-944-9760
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN010234012080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100130040Medicaid
A35886Medicare UPIN
145590DDDMedicare ID - Type Unspecified