Provider Demographics
NPI:1700907540
Name:RAICHLIN, EVGENIA (MD)
Entity Type:Individual
Prefix:
First Name:EVGENIA
Middle Name:
Last Name:RAICHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EUGENIA
Other - Middle Name:
Other - Last Name:RAICHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-6777
Mailing Address - Fax:414-955-6203
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-6777
Practice Address - Fax:414-955-6203
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73455207RA0001X, 207RC0000X, 207RA0001X
NE24648207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700907540Medicaid