Provider Demographics
NPI:1881678316
Name:RAAB, MICHAEL G (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:RAAB
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 1:9000 N MAIN ST
Mailing Address - Street 2:STE 227
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-832-4773
Mailing Address - Fax:937-832-2986
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:STE 227
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-832-4773
Practice Address - Fax:937-832-2986
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084997207X00000X
IN01065845A207X00000X
GA39661207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200926820Medicaid
P00714549OtherRAILROAD MEDICARE
GA000788136JMedicaid
OH2965831Medicaid
GA000788136JMedicaid
OHRA4262101Medicare PIN
OHH022360Medicare PIN
IN200926820Medicaid