Provider Demographics
NPI:1700831716
Name:RAILE, GEOFFREY D (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:D
Last Name:RAILE
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 1:6013 CHOWEN AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0538819Medicaid
MN100497OtherUCARE
MN1010338OtherPREFERRED ONE
MN47Q33RAOtherBLUE CROSS
MNHP14214OtherHEALTHPARTNERS
MN300085330OtherRAILROAD MEDICARE MN
WI34210600Medicaid
MN582648OtherAMERICA'S PPO
WIP00013857OtherRAILROAD MEDICARE WI
MN9F111RAOtherBLUE CROSS
MN542898000Medicaid
WIP00013857OtherRAILROAD MEDICARE WI
MNE54896Medicare UPIN
WI0015Medicare PIN
MNHP14214OtherHEALTHPARTNERS
MN582648OtherAMERICA'S PPO
MN47Q33RAOtherBLUE CROSS