Provider Demographics
NPI:1902912678
Name:RAINE, TALMAGE J (MD)
Entity Type:Individual
Prefix:
First Name:TALMAGE
Middle Name:J
Last Name:RAINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1405 W PARK ST
Mailing Address - Street 2:STE 206
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2365
Mailing Address - Country:US
Mailing Address - Phone:217-366-2650
Mailing Address - Fax:217-366-2652
Practice Address - Street 1:1405 W PARK ST
Practice Address - Street 2:STE 206
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2365
Practice Address - Country:US
Practice Address - Phone:217-366-2650
Practice Address - Fax:217-366-2652
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-08-12
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Provider Licenses
StateLicense IDTaxonomies
IL36-057908208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42825Medicare UPIN