Provider Demographics
NPI:1396963914
Name:RAUSCHKOLB, PAULA K (DO)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:K
Last Name:RAUSCHKOLB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3654 W ANTHEM WAY STE B106
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0455
Mailing Address - Country:US
Mailing Address - Phone:602-848-3906
Mailing Address - Fax:602-848-3454
Practice Address - Street 1:3654 W ANTHEM WAY STE B106
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0455
Practice Address - Country:US
Practice Address - Phone:602-848-3906
Practice Address - Fax:602-848-3454
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH174772084N0400X
IL036-1351482084N0400X
AZ0077612084N0400X
UT8292593-12042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036135148Medicare PIN
KSF400137997Medicare PIN