Provider Demographics
NPI:1912921297
Name:RAUCH, GREGORY S (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:RAUCH
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 1:6500 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4097
Mailing Address - Country:US
Mailing Address - Phone:773-388-1600
Mailing Address - Fax:708-364-7080
Practice Address - Street 1:6500 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4097
Practice Address - Country:US
Practice Address - Phone:773-388-1600
Practice Address - Fax:708-364-7080
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.113393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL705600OtherMEDICARE GROUP #
IL7400752OtherAETNA PROVIDER ID#
IL01630151OtherBCBS PROVIDER GROUP #
IL14D0991123OtherCLIA #
IL036113393Medicaid