Provider Demographics
NPI:1205985645
Name:RAUH, MICHAEL ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALFRED
Last Name:RAUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5959 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2291
Mailing Address - Country:US
Mailing Address - Phone:716-821-4400
Mailing Address - Fax:716-829-2138
Practice Address - Street 1:5959 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2291
Practice Address - Country:US
Practice Address - Phone:716-821-4400
Practice Address - Fax:716-829-2138
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219352207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02142487Medicaid
NYRB4827Medicare PIN