Provider Demographics
NPI:1366549412
Name:ALLEN K RAICH DPM PC
Entity type:Organization
Organization Name:ALLEN K RAICH DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-853-3015
Mailing Address - Street 1:1121 POPLAR VIEW LN N STE 2
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9339
Mailing Address - Country:US
Mailing Address - Phone:901-853-3018
Mailing Address - Fax:901-853-3015
Practice Address - Street 1:1121 POPLAR VIEW LN N STE 2
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9339
Practice Address - Country:US
Practice Address - Phone:901-853-3018
Practice Address - Fax:901-853-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNDPM228213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731576Medicaid
TN4106735OtherBCBS OF TN
TN900276068OtherRAILROAD MEDICARE
TN6138160001Medicare NSC
TN3731576Medicaid
TN3731576Medicare PIN
TN6138160001Medicare NSC
TN3351106Medicare ID - Type Unspecified