Provider Demographics
NPI:1083660336
Name:RAUP, AIMEE (DO)
Entity type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:
Last Name:RAUP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-471-1068
Mailing Address - Fax:
Practice Address - Street 1:2325 VIDINA DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7698
Practice Address - Country:US
Practice Address - Phone:321-471-1068
Practice Address - Fax:321-434-9285
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8659207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15436XOtherHFMG FL MEDICARE
FL264174700Medicaid
FL15436YMedicare PIN