Provider Demographics
NPI:1104876887
Name:RAUCH, KRISTIN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ANN
Last Name:RAUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 FORT MISSOULA RD
Mailing Address - Street 2:#115
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7420
Mailing Address - Country:US
Mailing Address - Phone:406-728-4292
Mailing Address - Fax:406-728-5770
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:#115
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7420
Practice Address - Country:US
Practice Address - Phone:406-728-4292
Practice Address - Fax:406-728-5770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6338207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000096350OtherBLUE CROSS BLUE SHIELD
MT0100711Medicaid
MT810486547OtherTAX ID NUMBER
MT0100711Medicaid
MTD96355Medicare UPIN