Provider Demographics
NPI:1013173053
Name:ELIZABETH W. RAUSCHKOLB, MD
Entity Type:Organization
Organization Name:ELIZABETH W. RAUSCHKOLB, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAUSCHKOLB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-823-3254
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-0531
Mailing Address - Country:US
Mailing Address - Phone:440-823-3254
Mailing Address - Fax:
Practice Address - Street 1:26777 LORAIN RD STE 508
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3223
Practice Address - Country:US
Practice Address - Phone:440-823-3254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35022265R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A75750Medicare UPIN