Basic Information
| Provider Information | |||||||||
| NPI: | 1699700625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAU | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5109 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 16179 | 05 | ND | MEDICAID | 9357 | 01 | ND | NDBS # | OTHER | 0404078 | 01 | ND | MEDICA # | OTHER | 48684RA | 01 | ND | MNBS # | OTHER | 29144RA | 01 | MN | MNBS # | OTHER | 424572500 | 05 | ND | MEDICAID | 80949RA | 01 | ND | MNBS # | OTHER | 909828 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | AR2952287 | 01 | ND | DEA # | OTHER | HP19574 | 01 | ND | HEALTHPARTNERS # | OTHER | ND100010 | 01 | ND | LHS # | OTHER | 0402520 | 01 | ND | MEDICA # | OTHER | 10709 | 01 | MN | NDBS # | OTHER | DA9011015577 | 01 | ND | PREFERRED ONE # | OTHER | 142052 | 01 | ND | UCARE # | OTHER | 15639 | 01 | ND | SIOUX VALLEY # | OTHER |