Provider Demographics
NPI:1861508244
Name:RAUSCHENBERGER, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:RAUSCHENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-4500
Mailing Address - Fax:920-682-9378
Practice Address - Street 1:1650 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-320-4500
Practice Address - Fax:920-682-9378
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI22510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI080069334OtherMEDICARE RAILROAD
WI390806395OtherCHAMPUS
WI390806395008OtherTRICARE
WI30277700Medicaid
WI390806395OtherWEA
WIB55955OtherCIGNA
WI00001598645 02OtherUNITED HEALTH
WI22510OtherTOUCHPOINT
WI7412OtherNETWORK HEALTH
WI390806395OtherWEA
WI390806395008OtherTRICARE