Provider Demographics
NPI:1316147564
Name:RAUSCHER, FREDERICK M (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:RAUSCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W ILES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7015
Mailing Address - Country:US
Mailing Address - Phone:217-698-3030
Mailing Address - Fax:217-698-4728
Practice Address - Street 1:2020 W ILES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7015
Practice Address - Country:US
Practice Address - Phone:217-698-3030
Practice Address - Fax:217-698-4728
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99072207W00000X
IL036120155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00621420OtherRAILROAD MEDICARE
IL036120155Medicaid
IL0364520001Medicare NSC
PAK51643Medicare UPIN