Provider Demographics
NPI:1942252325
Name:JOHN L. RAUSCH, MD, INC.
Entity Type:Organization
Organization Name:JOHN L. RAUSCH, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-592-1054
Mailing Address - Street 1:151 LANIPO DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3228
Mailing Address - Country:US
Mailing Address - Phone:808-262-4203
Mailing Address - Fax:
Practice Address - Street 1:629 KAILUA RD
Practice Address - Street 2:SUITE 205
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2853
Practice Address - Country:US
Practice Address - Phone:808-592-1054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 5461207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC98602Medicare UPIN