Provider Demographics
NPI:1588357255
Name:RAU, MICKEY E (RSS INTERN)
Entity type:Individual
Prefix:
First Name:MICKEY
Middle Name:E
Last Name:RAU
Suffix:
Gender:F
Credentials:RSS INTERN
Other - Prefix:
Other - First Name:MICKEY
Other - Middle Name:E
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:300 S ROSELLE RD APT 401
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1623
Mailing Address - Country:US
Mailing Address - Phone:630-673-1812
Mailing Address - Fax:
Practice Address - Street 1:10200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-3139
Practice Address - Country:US
Practice Address - Phone:847-455-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program