Provider Demographics
NPI:1851498281
Name:RAKOWSKY, KATRINA CISARUK (DO)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:CISARUK
Last Name:RAKOWSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4100 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7099
Mailing Address - Country:US
Mailing Address - Phone:216-491-7362
Mailing Address - Fax:216-491-6587
Practice Address - Street 1:4100 WARRENSVILLE CENTER ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7099
Practice Address - Country:US
Practice Address - Phone:216-491-7362
Practice Address - Fax:216-491-6587
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34007101204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000147311OtherANTHEM BCBS
OH2195075Medicaid
OHRA0885991Medicare ID - Type Unspecified
OH2195075Medicaid