Provider Demographics
NPI:1972840304
Name:MATHIS, RACHEL ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:MATHIS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:530 N LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1004
Mailing Address - Country:US
Mailing Address - Phone:574-234-4176
Mailing Address - Fax:574-234-1561
Practice Address - Street 1:530 N LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1004
Practice Address - Country:US
Practice Address - Phone:574-234-4176
Practice Address - Fax:574-234-1561
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01063452A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology