Provider Demographics
NPI:1831184720
Name:RAIS, THEODOR B (MD)
Entity type:Individual
Prefix:DR
First Name:THEODOR
Middle Name:B
Last Name:RAIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-7146
Mailing Address - Fax:419-383-2050
Practice Address - Street 1:3130 GLENDALE AVE
Practice Address - Street 2:KOBACKER CENTER
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5811
Practice Address - Country:US
Practice Address - Phone:419-383-3815
Practice Address - Fax:419-383-3098
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350767842084F0202X, 2084P0800X, 2084P0804X
UT278413-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2144183Medicaid
G31092Medicare UPIN
OH2144183Medicaid