Provider Demographics
NPI:1548268527
Name:RAUF, ABDUR (MD)
Entity type:Individual
Prefix:
First Name:ABDUR
Middle Name:
Last Name:RAUF
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 1:30 W MCCREIGHT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1842
Mailing Address - Country:US
Mailing Address - Phone:937-399-8889
Mailing Address - Fax:937-399-8996
Practice Address - Street 1:30 W MCCREIGHT AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1842
Practice Address - Country:US
Practice Address - Phone:937-399-8889
Practice Address - Fax:937-399-8996
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057339174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2920038OtherUNITED HEALTH CARE
OH0707613Medicaid
OH100006323OtherRAILROAD MEDICARE
OH311394313026OtherCARESOURCE
406636OtherAETNA
OH000000017009OtherBLUE CROSS BLUE SHIELD
OH0707613Medicaid
OH000000017009OtherBLUE CROSS BLUE SHIELD
OH2920038OtherUNITED HEALTH CARE