Provider Demographics
NPI:1407014657
Name:RAPP, BRIAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:RAPP
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:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-452-1188
Mailing Address - Fax:
Practice Address - Street 1:7303 ROGERS AVE STE 302
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4105
Practice Address - Country:US
Practice Address - Phone:479-452-1188
Practice Address - Fax:479-452-1196
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013873A208600000X
IN01067593A2086S0129X
OH35.1279262086S0129X
ARE-194862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201106000Medicaid
IN201106000Medicaid