Provider Demographics
NPI:1417397977
Name:DUNHAM, RACHEL E (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:206 W WARREN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9410
Practice Address - Country:US
Practice Address - Phone:574-825-2146
Practice Address - Fax:574-825-2182
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01076446A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201171810Medicaid
IN201171810Medicaid
IN162520047Medicare PIN