Provider Demographics
NPI:1821414210
Name:RAUCH, ANDREW (MCMSC, PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:RAUCH
Suffix:
Gender:M
Credentials:MCMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2426
Mailing Address - Country:US
Mailing Address - Phone:305-931-8484
Mailing Address - Fax:305-936-1849
Practice Address - Street 1:18600 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2426
Practice Address - Country:US
Practice Address - Phone:305-931-8484
Practice Address - Fax:305-936-1849
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant